Journal of Scientific Dentistry

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VOLUME 10 , ISSUE 1 ( January-June, 2020 ) > List of Articles

Original Article

Association between Serum Creatinine and Periodontal Disease Severity—A Comparative Clinicobiochemical Study

Aravindraaj Velayutham, Pratebha Balu, Saravanakumar Ravindran

Keywords : Association, Periodontitis, Renal diseases, Serum creatinine

Citation Information : Velayutham A, Balu P, Ravindran S. Association between Serum Creatinine and Periodontal Disease Severity—A Comparative Clinicobiochemical Study. 2020; 10 (1):3-6.

DOI: 10.5005/jp-journals-10083-0929

License: CC BY-NC 4.0

Published Online: 07-10-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

Objectives: Periodontitis is a chronic inflammatory disease of the periodontium that produces adverse systemic effects including diabetes mellitus, adverse pregnancy outcomes, respiratory illness, etc. Based on new studies, chronic inflammation is speculated as a risk factor for impairment of kidney function. Periodontitis, as long time inflammation is posed as one of the nontraditional risk factors for end-stage renal diseases. Literature search reveals contradicting evidence on the influence of periodontal infection and inflammation on the renal function. In lieu of the above, this study aims in estimating and comparing the serum creatinine (SCR) levels with periodontal disease status in systemically healthy subjects. Materials and methods: A total of 45 systemically healthy patients were recruited, and based on their periodontal status, they were divided into two groups: Group I (n = 22)—subjects with periodontitis and Group II (n = 23)—periodontally healthy subjects. Group I was again categorized into mild (CAL 1–2 mm), moderate (CAL 2–4 mm), and severe (CAL ≥ 5 mm) based on the severity of the periodontal disease. After assessing the clinical parameters, blood was collected for SCR estimation. The comparison between PPD, CAL, and SCR was done using the paired t-test. The comparison of SCR levels with severity of the periodontitis (CAL) was done using ANOVA. All the statistical analyzes were performed using SPSS 17 software. Results: The SCR value in Group I was 1.06 ± 0.13 and in Group II, 1.17 ± 0.16. Using the paired t-test to compare the creatinine values revealed that the difference between the two groups was statistically significant (p = 0.00001). By comparing the SCR levels with the severity of the periodontal disease, the mean value for mild periodontitis cases was 1.1 ± 0.12; for moderate periodontitis cases, 1.09 ± 0.25; and for severe periodontitis cases, 1.14 ± 0.14. ANOVA test values between the groups showed a statistical significance (p < 0.01). Conclusion: The results from this study showed an inverse relationship between SCR levels and periodontitis. The causal relationship between periodontitis and low SCR could not be established. This inverse relationship might confound the analysis of the link between renal function and periodontal disease. From the results of this study, we conclude that considering other indices such as cystatin C and creatinine clearance is preferable, to explore the association between renal function and periodontal disease.


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  1. American Academy of Periodontology. International workshop for a classification of periodontal disease and conditions. Ann Periodontol 1999;4(1):1–112. DOI: 10.1902/annals.1999.4.1.1.
  2. Papapanou PN, Trevisan M. Periodontitis and atherosclerotic vascular disease, what we know and why it is important. J Am Dent Associat 2012;143(8):826–828. DOI: 10.14219/jada.archive.2012.0275.
  3. Ide M, Papapanou PN. Epidemiology of association between maternal periodontal disease and adverse pregnancy outcomes- systematic review. J Clin Periodontol, 2013;40(suppl s14):S181–S194. DOI: 10.1902/jop.2013.134009.
  4. 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.
  5. Anil S, Al Ghamdi HS. The impact of periodontal infections on systemic diseases. an update for medical practitioners. Saudi Med J 2006;27(6):767–776.
  6. Bullon P, Morillo JM, Ramirez-Tortosa MC, Quiles JL, Newman HN, Battino M. Metabolic syndrome and periodontitis: is oxidative stress a common link. J Dent Res 2009;88(6):503–518. DOI: 10.1177/0022034509337479.
  7. Harita N, Hayashi T, Sato KK, Nakamura Y, Yoneda T, Endo G, et al. Lower serum creatinine is a new risk factor of type 2 diabetes: the Kansai healthcare study. Diabetes Care 2009;32(3):424–426. DOI: 10.2337/dc08-1265.
  8. Perrone RD, Madias NE, Levey AS. Serum creatinine as an index of renal function: new insights into old concepts. Clin Chem 1992;38(10): 1933–1953. DOI: 10.1093/clinchem/38.10.1933.
  9. Joseph R, Krishnan R, Narayan V. Higher prevalence of periodontal disease among patients with predialytic renal disease. Braz J Oral Sci 2009;8:14–18.
  10. Rahmati MA, Craig RG, Homel P, Kaysen GA, Levin NW. Serum markers of periodontal disease status and inflammation in hemodialysis patients. Am J Kidney Dis 2002;40(5):983–989. DOI: 10.1053/ajkd.2002.36330.
  11. Kshirsagar AV, Moss KL, Elter JR, Beck JD, Offenbacher S, Falk RJ. Periodontal disease is associated with renal insufficiency in the atherosclerosis risk in communities (ARIC) study. Am J Kidney Dis 2005;45(4):650–657. DOI: 10.1053/j.ajkd.2004.12.009.
  12. Jansson L, Lavstedt S, Frithiof I, Theobald H. Relationship between oral health and mortality in cardiovascular diseases. J Clin Periodontol 2001;28(8):762–768. DOI: 10.1034/j.1600-051x.2001.280807.x.
  13. Tuominen R, Reunanen A, Paunio M, Paunio J, Aromaa A. Oral health indicators poorly predict coronary heart disease deaths. J Dent Res 2003;82(9):713–718. DOI: 10.1177/154405910308200911.
  14. Sedý J, Horká E, Foltán R, Spacková J, Dusková J. Mechanism of increased mortality in hemodialysed patients with periodontitis. Med Hypotheses 2010;74(2):374–376. DOI: 10.1016/j.mehy.2009.04.053.
  15. Sreeram M, Suryakar AN, Dani NH, Kulkarni MB. Is periodontitis associated with decreased glomerular filtration rate, with oxidative stress as an important link? IOSR J Dent Med Sci (IOSR-JDMS) 2013;12(3):41–47. DOI: 10.9790/0853-1234147.
  16. Chambrone L, Foz AM, Guglielmetti MR, Pannuti CM, Artese HP, Feres M, et al. Periodontitis and chronic kidney disease: a systematic review of the association of diseases and the effect of periodontal treatment on estimated glomerular filtration rate. J Clin Periodontol 2013;40(5):443–456. DOI: 10.1111/jcpe.12067.
  17. Yamalik N, Delilbasi L, Gulay H, Caglayan F, Haberal M, Caglayan G. The histological investigation of gingiva from patients with chronic renal failure, renal transplants, and periodontitis: a light and electron microscopic study. J Periodontol 1991;62(12):737–744. DOI: 10.1902/jop.1991.62.12.737.
  18. Wahid A, Chaudhry S, Ehsan A, Butt S, Ali Khan A. Bidirectional relationship between chronic kidney disease & periodontal disease. Pak J Med Sci 2013;29(1):211–215. DOI: 10.12669/pjms.291.2926.
  19. Barbudo-Selmi GR, Carvalho MB, Selmi AL, Selmi AL, Martins SEC. Periodontal disease characterization in dogs with normal renal function or chronic renal failure. Ciênc Rural 2004;34(1):113–118. DOI: 10.1590/S0103-84782004000100017.
  20. Taylor BA, Tofler GH, Carey HMR, Morel-Kopp MC, Philcox S, Carter TR, et al. Full-mouth tooth extraction lowers systemic inflammatory and thrombotic markers of cardiovascular risk. J Dent Res 2006;85(1): 74–78. DOI: 10.1177/154405910608500113.
  21. Wei F, Cheng S, Korin Y, Reed EF, Gjertson D, Ho C, et al. Serum creatinine detection by a conducting-polymer-based electrochemical sensor to identify allograft dysfunction. Anal Chem 2012;84(18):7933–7937. DOI: 10.1021/ac3016888.
  22. Marcotte L, Godwin M. Natural history of elevated creatinine levels. Can Fam Physician 2006;52(10):1264–1265.
  23. Sato KK, Hayashi, Harita N, Koh H, Maeda I, Endo G, et al. Elevated white blood cell count worsens proteinuria but not estimated glomerular filtration rate: the Kansai healthcare study. Am J Nephrol 2011;34(4):324–329. DOI: 10.1159/000330845.
  24. DeFronzo RA, Gunnarsson R, Björkman O, Olsson M, Wahren J. Effects of insulin on peripheral and splanchnic glucose metabolism in noninsulin-dependent (type II) diabetes mellitus. J Clin Invest 1985;76(1):149–155. DOI: 10.1172/JCI111938.
  25. Banfi G, Del Fabbro M, Lippi G. Relation between serum creatinine and body mass index in elite athletes of different sport disciplines. Br J Sports Med 2006;40(8):675–678. DOI: 10.1136/bjsm.2006.026658.
  26. Al-Zahrani MS, Bissada NF, Borawskit EA. Obesity and periodontal disease in young, middle-aged, and older adults. J Periodontol 2003;74(5):610–615. DOI: 10.1902/jop.2003.74.5.610.
  27. Dalla Vecchia CF, Susin C, Rösing CK, Oppermann RV, Albandar JM. Overweight and obesity as risk indicators for periodontitis in adults. J Periodontol 2005;76(10):1721–1728. DOI: 10.1902/jop.2005.76. 10.1721.
  28. Hjelmesth J, Røislien J, Nordstrand N, Hofsø D, Hager H, Hartmann A. Low serum creatinine is associated with type 2 diabetes in morbidly obese women and men: A cross-sectional study. BMC Endocr Disord 2010;10(1):6. DOI: 10.1186/1472-6823-10-6.
  29. Inaba M, Kurajoh M, Okuno S, Imanishi Y, Yamada S, Mori K, et al. Poor muscle quality rather than reduced lean body mass is responsible for the lower serum creatinine level in hemodialysis patients with diabetes mellitus. Clin Nephrol 2010;74(4):266–272.
  30. Brotto RS, Vendramini RC, Brunetti IL, Marcantonio RAC, Ramos APP, Pepato MT. Lack of correlation between periodontitis and renal dysfunction in systemically healthy patients. Eur J Dent 2011;5(1):8–18. DOI: 10.1055/s-0039-1698853.
  31. Shimazaki Y, Kushiyama M, Murakami M, Yamashita Y. Relationship between normal serum creatinine concentration and periodontal disease in japanese middle-aged males. J Periodontol 2013;84(1): 94–100. DOI: 10.1902/jop.2012.110528.
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