Abstract
BackgroundThis systematic review aimed to investigate whether non-surgical periodontal therapy (NSPT) can reduce systemic inflammatory levels and improve metabolism in patients undergoing haemodialysis (HD) and/or peritoneal dialysis (PD).MethodsElectronic databases (PubMed, EMBASE, CENTRAL, CNKI, and WFPD) were searched for randomized controlled trials (RCTs) performed through July 2019. The risk of bias within studies was assessed with the Cochrane Collaboration’s risk assessment tool. The systemic inflammatory and metabolic outcomes included the highly sensitive C-reactive protein (hs-CRP), interleukin 6 (IL-6), tumour necrosis factor-a (TNF-a), the albumin (Alb), and lipid metabolite levels. Meta-analyses (MAs) were performed to calculate the overall effect size where appropriate.ResultsFive RCTs were included in this study. Compared with untreated periodontitis groups, the dialysis patients after NSPT significantly showed decreased hs-CRP levels at less than or equal to 2 months (standardized mean difference: − 1.53, 95% confidence interval − 2.95 to − 0.11). No significant difference was found in IL-6 and Alb levels following NSPT at either the 3- or 6- month follow-ups. No MAs could be performed on the TNF-a level and the lipid metabolic markers.ConclusionsNSPT can moderately reduce serum hs-CRP levels in HD and/or PD patients, but did not significantly change IL-6 or Alb levels. For TNF-a and lipid metabolism markers, no sufficient evidence supports that these levels are changed after NSPT. Additional scientific research is necessary to assess the effects of NSPT on systemic inflammation and metabolic parameters in dialysis patients.
Highlights
This systematic review aimed to investigate whether non-surgical periodontal therapy (NSPT) can reduce systemic inflammatory levels and improve metabolism in patients undergoing haemodialysis (HD) and/or peritoneal dialysis (PD)
The production of local periodontal proinflammatory and inflammatory factors is related to the host’s systemic inflammatory and immunological response [11], and there may be a bidirectional relationship between End-stage renal disease (ESRD) and chronic periodontitis
Five randomized controlled clinical trial (RCT) were included for systematic assessment (Fig. 1)
Summary
This systematic review aimed to investigate whether non-surgical periodontal therapy (NSPT) can reduce systemic inflammatory levels and improve metabolism in patients undergoing haemodialysis (HD) and/or peritoneal dialysis (PD). The elevated risk or severity of periodontal disease in dialysis patients may be associated with high levels of serum inflammatory biomarkers and low levels of serum Alb [15,16,17]. The control of systemic inflammation and metabolic markers in dialysis patients may reduce the CVD rate and atherosclerosis, improve the prognosis of ESRD and improve the pathological progression of periodontal diseases [11, 18, 19]
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