Clinical response to nonsurgical periodontal therapy is associated with decreased serum leukocyte count and uric acid levels in kidney transplant recipients
DOI:
https://doi.org/10.1590/1678-7757-2024-0206Keywords:
Periodontal disease, Nonsurgical periodontal therapy, Kidney transplantation, BiomarkerAbstract
Objective: This study sought to investigate the relationship between clinical response to nonsurgical periodontal therapy (NSPT) and serum changes in leukocyte count, fasting blood glucose, hemoglobin, hematocrit, creatinine, and uric acid in kidney transplant recipients (KTR). Methodology: A prospective study was performed on 20 KTRs. Periodontal and serum data were collected before and 90 days after NSPT, and delta values (Δ = after NSPT - before) were calculated. Periodontal assessment included periodontal probing depth (PPD), clinical attachment level (CAL), and bleeding on probing (BOP). Patients were classified based on the presence of periodontitis and then categorized into stages. Results: Patients showed a reduction in the percentage of sites with PPD≥3mm, PPD≥4 mm and BOP, after NSPT. There was a direct correlation between the deltas of leukocyte count and CAL ≥3 mm (r=0.645, P=0.002) and BOP (r=0.663, P=0.001), and the deltas of uric acid and CAL ≥3 mm (r=0.562, P=0.010). Conclusion: A good clinical response to NSPT may affect the reduction of serum levels of leukocyte count and uric acid, suggesting a beneficial effect on systemic health in KTR.
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References
- Kovesdy CP. Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl (2011). 2022;12(1):7-11. doi: 10.1016/j.kisu.2021.11.003
- Webster AC, Nagler EV, Morton RL, Masson P. Chronic kidney disease. Lancet. 2017;389(10075):1238-52. doi: 10.1016/S0140-6736(16)32064-5
- Schoot TS, Goto NA, van Marum RJ, Hilbrands LB, Kerckhoffs AP. Dialysis or kidney transplantation in older adults? A systematic review summarizing functional, psychological, and quality of life-related outcomes after start of kidney replacement therapy. Int Urol Nephrol. 2022;54(11):2891-900. doi: 10.1007/s11255-022-03208-2
- Guha C, van Zwieten A, Khalid R, Kim S, Walker A, Francis A, et al. Longitudinal assessment of the health-related quality of life of children and adolescents with chronic kidney disease. Kidney Int. 2023;103(2):357-64. doi: 10.1016/j.kint.2022.09.026
- Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: framework and proposal of a new classification and case definition. J Periodontol. 2018;89 Suppl 1:S159-S172. doi: 10.1002/JPER.18-0006
- Ray RR. Periodontitis: an oral disease with severe consequences. Appl Biochem Biotechnol. 2023;195(1):17-32. doi: 10.1007/s12010-022-04127-9
- Kapellas K, Singh A, Bertotti M, Nascimento GG, Jamieson LM, Perio-CKD collaboration. Periodontal and chronic kidney disease association: a systematic review and meta-analysis. Nephrology (Carlton). 2019;24(2):202-12. doi: 10.1111/nep.13225
- He I, Poirier B, Jensen E, Kaur S, Hedges J, Jesudason S, et al. Demystifying the connection between periodontal disease and chronic kidney disease: an umbrella review. J Periodontal Res. 2023;58(5):874-92. doi: 10.1111/jre.13161
- Sasaki H, Tanabe T, Tsuji T, Hotta K. Mechanism and treatment for chronic antibody-mediated rejection in kidney transplant recipients. Int J Urol. 2023;30(8):624-33. doi: 10.1111/iju.15197
- Nunes-dos-Santos DL, Gomes SV, Rodrigues VP, Pereira AL. Periodontal status and clinical outcomes in kidney transplant recipients: a systematic review. Oral Dis. 2020;26(1):22-34. doi: 10.1111/odi.13040
- Lobão W, Carvalho R, Leite S, Rodrigues VP, Batista JE, Gomes-Filho IS, et al. Relationship between periodontal outcomes and serum biomarkers changes after non-surgical periodontal therapy. An Acad Bras Cienc. 2019;91(2):e20170652. doi: 10.1590/0001-3765201920170652
- Berezow AB, Darveau RP. Microbial shift and periodontitis. Periodontol 2000. 2011;55(1):36-47. doi: 10.1111/j.1600-0757.2010.00350.x
- Heitz-Mayfield LJA, Lang NP. Surgical and nonsurgical periodontal therapy: learned and unlearned concepts. Periodontol 2000. 2013;62(1):218-31. doi: 10.1111/prd.12008
- Fang F, Wu B, Qu Q, Gao J, Yan W, Huang X, et al. The clinical response and systemic effects of non-surgical periodontal therapy in end-stage renal disease patients: a 6-month randomized controlled clinical trial. J Clin Periodontol. 2015;42(6):537-46. doi: 10.1111/jcpe.12411
- Tasdemir Z, Özsarı Tasdemir F, Gürgan C, Eroglu E, Gunturk I, Kocyigit I. The effect of periodontal disease treatment in patients with continuous ambulatory peritoneal dialysis. Int Urol Nephrol. 2018;50(8):1519-28. doi: 10.1007/s11255-018-1913-y
- Yue H, Xu X, Liu Q, Li X, Xiao Y, Hu B. Effects of non-surgical periodontal therapy on systemic inflammation and metabolic markers in patients undergoing haemodialysis and / or peritoneal dialysis: a systematic review and meta-analysis. BMC Oral Heal. 2020;20(1):18. doi: 10.1186/s12903-020-1004-1
- Rodrigues VP, Libério SA, Lopes FF, Thomaz EB, Guerra RN, Gomes-Filho IS, et al. Periodontal status and serum biomarkers levels in haemodialysis patients. J Clin Periodontol. 2014;41(9):862-8. doi: 10.1111/jcpe.12283
- Deschamps-Lenhardt S, Martin-Cabezas R, Hannedouche T, Huck O. Association between periodontitis and chronic kidney disease: systematic review and meta-analysis. Oral Dis. 2019;25(2):385-402. doi: 10.1111/odi.12834
- Zhao D, Khawaja AT, Jin L, Li KY, Tonetti M, Pelekos G. The directional and non-directional associations of periodontitis with chronic kidney disease: a systematic review and meta-analysis of observational studies. J Periodontal Res. 2018;53(5):682-704. doi: 10.1111/jre.12565
- Yoshihara A, Sugita N, Iwasaki M, Wang Y, Miyazaki H, Yoshie H, et al. Relationship between renal function and periodontal disease in community-dwelling elderly women with different genotypes. J Clin Periodontol. 2017;44(5):484-9. doi: 10.1111/jcpe.12708
- Schöffer C, Oliveira LM, Santi SS, Antoniazzi RP, Zanatta FB. C-reactive protein levels are associated with periodontitis and periodontal inflamed surface area in adults with end-stage renal disease. J Periodontol. 2021;92(6):793-802. doi: 10.1002/JPER.20-0200
- Gomes SV, Rodrigues V, Nunes-dos-Santos DL, Pereira AL, Peres MA. The relationship between periodontal status and hyperglycemia after kidney transplantation. Clin Oral Investig. 2022;26(1):397-406. doi: 10.1007/s00784-021-04011-6
- Rocha LC, Nunes-dos-Santos DL, Costa EM, Gomes SV, Rodrigues VP, Pereira AL. A cross-sectional study of the association between chronic oral disease burden and serum biomarkers in kidney transplant recipients. Prog Transplant. 2022;32(1):49–54. doi: 10.1177/15269248211064889
- Associação Brasileira de Transplante de Órgãos. Dimensionamento dos transplantes no Brasil e em cada estado (2015-2022) [Sizing of transplants in Brazil and its states]. Regist Bras Transpl [Internet]. 2022 [cited 2023 Dec 20];29(4):1-88. Portuguese. Available from: https://site.abto.org.br/wp-content/uploads/2023/03/rbt2022-naoassociado.pdf
- Salvi GE, Roccuzzo A, Imber JC, Stähli A, Klinge B, Lang NP. Clinical periodontal diagnosis. Periodontol 2000. Forthcoming 2023. doi:10.1111/prd.12487
- Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J. 1975;25(4):229-35.
- Azeez HW, Abdulhaq AA, Salih ZA. Impact of non-surgical periodontal treatment on total WBC count in patients with periodontitis. Erbil Dent J. 2018;1(2):86-92. doi: 10.15218/edj.2018.12
- Sanz M, Herrera D, Kebschull M, Chapple I, Jepsen S, Berglundh T, et al. Treatment of stage I–III periodontitis—The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020;47 Suppl 22(Suppl 22):4-60. doi: 10.1111/jcpe.13290
- National Institutes of Dental and Craniofacial Research. Dental management of the organ or stem cell transplant patient [Internet]. Bethesda: NIDCR; 2016 [cited 2024 July 10]. Available from: https://www.nidcr.nih.gov/sites/default/files/2017-09/dental-management-organ-stem-cell-transplant.pdf
- Hada DS, Garg S, Ramteke GB, Ratre MS. Effect of non-surgical periodontal treatment on clinical and biochemical risk markers of cardiovascular disease: a randomized trial. J Periodontol. 2015;86(11):1201-11. doi: 10.1902/jop.2015.150249
- Yuan Q, Wang J, Peng Z, Zhou Q, Xiao X, Xie Y, et al. Neutrophil-to-lymphocyte ratio and incident end-stage renal disease in Chinese patients with chronic kidney disease: results from the Chinese cohort study of chronic kidney disease (C-STRIDE). J Transl Med. 2019;17(1):86. doi: 10.1186/s12967-019-1808-4
- Wheelock KM, Saulnier PJ, Tanamas SK, Vijayakumar P, Weil EJ, Looker HC, et al. White blood cell fractions correlate with lesions of diabetic kidney disease and predict loss of kidney function in Type 2 diabetes. Nephrol Dial Transplant. 2018;33(6):1001-9. doi: 10.1093/ndt/gfx231
- Stevens PE, Levin A. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158(11):825-30. doi: 10.7326/0003-4819-158-11-201306040-00007
- Park C, Yoo K, Lee S, Kim H, Son E, Lee D, et al. The prognostic significance of leukocyte count on all-cause and cardiovascular disease mortality: a systematic review and meta-analysis. Am J Cardiol. 2023;203:226-33. doi: 10.1016/j.amjcard.2023.06.119
- Silva M Jr, Marra AR, Pereira CA, Medina-Pestana JO, Camargo LF. Bloodstream infection after kidney transplantation: epidemiology, microbiology, associated risk factors, and outcome. Transplantation. 2010;90(5):581-7. doi: 10.1097/TP.0b013e3181e8a680
- Shao M, Wan Q, Xie W, Ye Q. Bloodstream infections among solid organ transplant recipients: epidemiology, microbiology, associated risk factors for morbility and mortality. Transplant Rev (Orlando). 2014;28(4):176-81. doi: 10.1016/j.trre.2014.02.001
- Liu H, Ye Q, Wan Q, Zhou J. Predictors of mortality in solid-organ transplant recipients with infections caused by Acinetobacter baumannii. Ther Clin Risk Manag. 2015;11:1251-7. doi:10.2147/TCRM.S91277
- Christan C, Dietrich T, Hägewald S, Kage A, Bernimoulin JP. White blood cell count in generalized aggressive periodontitis after non-surgical therapy. J Clin Periodontol. 2002;29(3):201-6. doi: 10.1034/j.1600-051x.2002.290303.x
- Siddeshappa S, Nagdeve S, Yeltiwar R, Parvez H, Deonani S, Diwan V. Evaluation of various hematological parameters in patients with periodontitis after nonsurgical therapy at different intervals. J Ind Soc Periodontol. 2016;20(2):180-3. doi: 10.4103/0972-124X.175172
- Joo JY, Park HR, Cho Y, Noh Y, Lee CH, Lee SG. Increased prevalence of periodontitis with hypouricemic status: findings from the Korean National Health and Nutrition Examination Survey, 2016-2018. J Periodontal Implant Sci. 2023;53(4):283-94. doi: 10.5051/jpis.2202220111
- Li L, Yang C, Zhao Y, Zeng X, Liu F, Fu P. Is hyperuricemia an independent risk factor for new-onset chronic kidney disease? A systematic review and meta-analysis based on observational cohort studies. BMC Nephrol. 2014;15:122. doi: 10.1186/1471-2369-15-122
- Skoczyńska M, Chowaniec M, Szymczak A, Langner-Hetmańczuk A, Maciążek-Chyra B, Wiland P. Pathophysiology of hyperuricemia and its clinical significance: a narrative review. Reumatologia. 2020;58(5):312-23. doi: 10.5114/reum.2020.100140
- Jeong H, Moon JE, Jeon CH. Hyperuricemia is associated with an increased prevalence of metabolic syndrome in a general population and a decreased prevalence of diabetes in men. J Rheum Dis. 2020;27(4):247-60. doi: 10.4078/jrd.2020.27.4.247
- Srivastava A, Kaze AD, McMullan CJ, Isakova T, Waikar SS. Uric acid and the risks of kidney failure and death in individuals with CKD. Am J Kidney Dis. 2018;71(3):362-70. doi: 10.1053/j.ajkd.2017.08.017
- Gharbi A, Hamila A, Bouguezzi A Dandana A, Ferchichi S, Chandad F, et al. Biochemical parameters and oxidative stress markers in Tunisian patients with periodontal disease. BMC Oral Health. 2019;19(1):225. doi: 10.1186/s12903-019-0912-4
- Banu S, Jabir NR, Mohan R, Manjunath NC, Kamal MA, Kumar KRV, et al. Correlation of toll-like receptor 4, interleukin-18, transaminases, and uric acid in patients with chronic periodontitis and healthy adults. J Periodontol. 2015;86(3):431-9. doi: 10.1902/jop.2014.140414
- Ye LW, Zhao L, Mei ZS, Zhou YH, Yu T. Association between periodontitis and uric acid levels in blood and oral fluids: a systematic review and meta-analysis. BMC Oral Health. 2023;23(1):178. doi: 10.1186/s12903-023-02900-8
- Roguljić M, Vučković M, Gelemanović A, Kovačević K, Orešković J, Radić M, et al. Risk factors of severe periodontitis in kidney transplant recipients: a case-control study. J Periodontol. 2023;94(6):765-76. doi: 10.1002/JPER.22-0351
- Shin YM, Mun KH. Glucose as a risk factor for periodontitis in kidney transplantation patients. Transplant Proc. 2023;55(2):350-3. doi: 10.1016/j.transproceed.2023.01.003
- Ziukaite L, Slot DE, Van der Weijden FA. Prevalence of diabetes mellitus in people clinically diagnosed with periodontitis: a systematic review and meta-analysis of epidemiologic studies. J Clin Periodontol. 2018;45(6):650-62. doi: 10.1111/jcpe.12839
- Chapple ILC, Genco R, Working group 2 of the joint EFP/AAP Workshop. Diabetes and periodontal diseases: consensus report of the Joint EFP/AAP Workshop on periodontitis and systemic diseases. J Periodontol. 2013;84(4 Suppl):S106-12. doi: 10.1902/jop.2013.1340011
- Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K, et al. Periodontitis and diabetes: a two-way relationship. Diabetologia. 2012;55(1):21-31. doi: 10.1007/s00125-011-2342-y
- Hall IE, Doshi MD, Poggio ED, Parikh CR. A comparison of alternative serum biomarkers with creatinine for predicting allograft function after kidney transplantation. Transplantation. 2011;91(1):48-56. doi: 10.1097/TP.0b013e3181fc4b3a
- Maamoun HA, Soliman AR, Fathy A, Elkhatib M, Shaheen N. Diabetes mellitus as predictor of patient and graft survival after kidney transplantation. Transplant Proc. 2013;45(9):3245-8. doi: 10.1016/j.transproceed.2013.08.030
- Kinoshita Y, Katano S, Nishida S, Shimizu T, Fujimura T, Kume H, et al. Creatinine reduction ratio on postoperative day 2 predicts long-term outcomes after living donor kidney transplantation. Int J Urol. 2022:29(2):114-20. doi: 10.1111/iju.14726
- Kasiske BL, Zeier MG, Chapman JR, Craig JC, Ekberg H, Gravey CA, et al. KDIGO clinical practice guideline for the care of kidney transplant recipients: a summary. Kidney Int. 2010;77(4):299-311. doi: 10.1038/ki.2009.377
- Vasanthan A, Dallal N. Periodontal treatment considerations for cell transplant and organ transplant patients. Periodontol 2000. 2007;44:82-102. doi: 10.1111/j.1600-0757.2006.00198.x
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Copyright (c) 2024 Samira Vasconcelos Gomes, Danila Lorena Nunes-Dos-Santos, Luciana Salles Branco-De-Almeida, Bruno Braga Benatti, Vandilson Rodrigues
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