Periodontal inflamed surface area in patients on haemodialysis and peritoneal dialysis: a Croatian cross-sectional study

Bojana Križan Smojver,Nikolina Bašić Jukić,Mladen Knotek,Andrej Aurer,Karmela Altabas

doi:10.1186/s12903-020-01086-7

Abstract

BackgroundThe decision to initiate dialysis treatment via haemodialysis (HD) or peritoneal dialysis (PD) often involves the consideration of complex factors and remains a matter of debate. The purpose of this study was to quantify the inflammatory burden that periodontitis causes in dialysis patients and to examine whether patients on PD and HD differ in terms of the periodontal inflamed surface area (PISA), which can be helpful for selecting the most appropriate dialysis modality.MethodsA cross-sectional study was performed on 58 consecutive patients on HD and 31 consecutive patients on PD. PISA was calculated using measurements of the clinical attachment level, recession and bleeding on probing. We performed the primary analysis using multivariable robust regression.ResultsPatients on PD had a 746 mm2 (93%) lower mean PISA than patients on HD after adjustment for 20 possible confounders, including the duration of dialysis. The type of dialysis was independently correlated with the PISA (semipartial correlation: − 0.50; p = 0.017; false discovery rate < 5%). After adjusting for confounding factors, the correlation between the duration and type of dialysis was not significant (F (2,44) = 0.01; p = 0.994; η2 = 0.00). Differences in the PISA between patients who had undergone dialysis for less than a year, 2–3 years or ≥ 3 years were not significantly different in either of the two dialysis groups.ConclusionsPISA levels in Croatian patients on dialysis indicate a high need for periodontal treatment. PD is associated with a smaller PISA independent of many sociodemographic, lifestyle, laboratory and clinical factors. The duration of dialysis does not influence PISA levels.Trial registrationISRCTN17887630.A clinical study to investigate gum infection in patients undergoing kidney dialysis.

Highlights

The decision to initiate dialysis treatment via haemodialysis (HD) or peritoneal dialysis (PD) often involves the consideration of complex factors and remains a matter of debate
There are five Chronic kidney disease (CKD) stages according to the estimated glomerular filtration rate, and the last stage is end-stage renal disease (ESRD) or kidney failure [1]
The aim of this study was to quantify the inflammatory burden that periodontitis poses in dialysis patients and to examine whether patients on PD and HD differ according to their periodontal inflamed surface area (PISA), which can be helpful in selecting the most appropriate dialysis modality

Summary

Introduction

The decision to initiate dialysis treatment via haemodialysis (HD) or peritoneal dialysis (PD) often involves the consideration of complex factors and remains a matter of debate. Chronic kidney disease (CKD) is defined as kidney damage or a glomerular filtration rate (GFR) of < 60 mL/ min/1.73 m2 for 3 months or more, irrespective of the cause [1]. There are five CKD stages according to the estimated glomerular filtration rate (eGFR), and the last stage is end-stage renal disease (ESRD) or kidney failure (eGFR < 15 ml/min/1.73 m) [1]. The decision to initiate dialysis treatment using haemodialysis or peritoneal dialysis is often complex and remains a matter of debate [2]. It has been shown that PD can provide similar or better survival rates and better quality of life and that PD is more economical than HD, in 2008, there were only 196,000 PD patients comprising 11% of the global dialysis population [3]

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