Does Periodontitis Reflect Inflammation and Malnutrition Status in Hemodialysis Patients

Background: Chronic infection and inflammation, including periodontitis, is linked to an increased risk for atherosclerosis. To investigate the possible adverse effects of periodontitis in maintenance hemodialysis patients, we compared periodontal severity with malnutrition and inflammation, which are associated with poor atherosclerotic outcome in hemodialysis patients. Methods: Two hundred fifty-three hemodialysis patients were included in this study to evaluate clinical periodontal status by using the Plaque Index, Gingival Index, and Periodontal Disease Index. Geographic, hematologic, biochemical, and dialysis-related data also were collected. Values for nutritional and inflammatory markers, such as albumin, blood urea nitrogen, creatinine, transferrin, absolute lymphocyte count, normalized protein catabolic rate, high-sensitivity C-reactive protein, and ferritin, were included for analysis with the Periodontal Index. Results: Poor oral health status was shown by 80.6% of hemodialysis patients with periodontal disease. In an analysis of geographic and disease-related parameters, we found that aging, smoking, diabetes, and longer dialysis duration were associated with severity of periodontitis. Parameters of malnutrition and inflammation also were associated with poor periodontal status. We next conducted multiple regression analysis and found that age, diabetes, smoking, albumin level, and dialysis duration were associated independently with periodontitis severity in hemodialysis patients. According to the severity of periodontitis, there were higher percentiles of patients with malnutrition (chi-square = 13.055; P = 0.005) and inflammation (chi-square = 10.046; P = 0.018) in the severe group. Conclusion: Periodontal health is poor in hemodialysis patients and correlates with markers of malnutrition and inflammation. Its diagnosis and treatment deserve better awareness.