Assessment of inflammatory markers and periodontal outcomes in CKD patients with periodontitis

Chronic kidney disease (CKD) and periodontitis have an impact on patient’s morbidity and mortality. The prevalence of comorbid CKD and periodontitis is shown to be frequent. Periodontitis increases the inflammatory burden, which has been shown to disrupt renal function by altering serum inflammatory levels, and potentially worsening CKD. Pro-inflammatory Interleukin-1 (IL-1) and anti-inflammatory Interleukin-10 (IL-10) have immunomodulatory properties that regulates host immune responses. Little is known about changes in the serum inflammatory markers of IL-1 and IL-10 following the periodontal therapy in CKD patients in our populations. Therefore, this study was aimed to assess and compare the levels of inflammatory markers IL-1 and IL-10 as well as periodontal parameters at baseline and after receiving NSPT. Twenty CKD patients (stage 3 and stage 4) with periodontitis (Group 1), twenty non-CKD patients with periodontitis (Group 2) and twenty healthy patients (Group 3) were selected. The dental parameters such as Periodontal Probing Depth (PPD), Clinical Attachment Loss (CAL), Gingival Bleeding Index (GI) and Plaque Score (PS) were measured in each patient during first visit (baseline) and six weeks later (second visit). Blood sample was collected during each visit and analysed for serum IL-1 and IL-10 concentration using Enzyme-Linked Immunosorbent Assay. Our findings shows that IL-1 and IL-10 levels were found significantly higher (p<0.05) in CKD patients with periodontitis (Group 1) as compared to non-CKD patients with periodontitis (Group 2) and healthy subjects (Group 3). When compared to other groups, the levels of dental parameters (PPD, PS and GBI in Group 1 were significantly higher (p<0.05). Following NSPT, there was significant reduction (p<0.05) in inflammatory markers and clinical periodontal parameters in Group 1 and Group 2. This study demonstrates that patients with CKD and periodontitis had a more severe systemic inflammatory response and poorer periodontal status than non-CKD. NSPT shown improvement in both inflammatory markers and dental parameters as well as delay the progression of CKD. IL-1 and IL-10 is a promising inflammatory marker to assess CKD progression. Therefore, multicentre and larger sample size studies are needed in the future

Nexus between periodontal disease and chronic kidney disease: a narrative review

Background: Several decades of research have established the relationships between systemic diseases and periodontal diseases. Chronic kidney disease (CKD) is a chronic medical condition in which the homeostatic and emunctory activity of the kidneys is progressively declines. Periodontitis is a complex, polymicrobial disease that involves both the host and the environment. Tissue destruction is primarily associated with the host’s hyperresponsiveness, resulting in the release of inflammatory markers. Aim: This paper reviewed the evidence linking CKD, inflammatory markers, and periodontal disease and the effect of periodontal therapy on inflammatory markers and kidney function as well as dental parameters. Setting and Design: The sources of data were compiled and reviewed from MEDLINE, SCOPUS and Web of Sciences from 2010 to 2021. Result and Discussion: This review identifies biologically plausible bidirectional nexus between periodontitis and CKD. Periodontitis has emerged as non-traditional risk factor of CKD and vice versa. In addition, inflammatory markers are considered to play a role in the linkages between periodontitis and CKD. Recent study, has linked an increase in the production of inflammatory markers to a poorer renal outcome in patients with CKD. Periodontal therapy is effective in lowering the inflammatory markers levels and periodontal parameters as well as halting the progression of CKD. Conclusion: Understanding these links may help in identifying high-risk individuals and providing essential care at an early stage

The assessment of interleukin-1 in chronic kidney disease patients with periodontitis following non-surgical periodontal therapy

Introduction: Chronic kidney disease (CKD) and periodontitis have an impact on patient’s morbidity and mortality. Periodontitis increases the inflammatory burden, which has been shown to impair renal function by altering serum inflammatory levels. Interleukin-1 (IL-1) has immunomodulatory properties that affect immunological responses of the host. Little is known regarding IL-1 alteration in CKD patients after non-surgical periodontal therapy (NSPT). Therefore, this study was aimed to assess and compare the level of IL-1 at baseline and after receiving NSPT. Materials & Methods: The study included twenty CKD patients with periodontitis (Group 1), twenty non-CKD patients with periodontitis (Group 2) and twenty healthy subjects (Group 3). During each visit, a blood sample was collected and the serum IL-1 concentration was analysed using enzyme-linked immunosorbent assay. Results: Our findings showed that IL-1 level was significantly higher (p<0.05) in Group 1 [Mean (SD) = 0.91(0.39)]pg/ml as compared to Group 2 [Mean (SD)= 0.79(0.27)]pg/ml and Group 3 [Mean (SD) = 0.57(0.39)]pg/ml. Following NSPT, there was significant reduction (p<0.05) in IL-1 level in Group 1 and Group 2. The eGFR has improved from [Mean (SD)= 25.25 (9.93)] mL/min/1.73m2 to 30.3(11.73) mL/min/1.73m2 post NSPT. Discussion: This study found that CKD patients with periodontitis exhibited a more severe systemic inflammatory response than non-CKD patients and healthy subjects. NSPT reduced the inflammatory markers and delay the progression of CKD. IL-1 is a promising inflammatory marker for monitoring CKD progression. Therefore, multicentre and larger sample size studies are needed in the future

The assessment of interleukin-10 and periodontal parameters in chronic kidney disease patients with inflammation of the gum and tooth-supporting tissues following periodontal therapy

Introduction: Chronic kidney disease (CKD) is characterized by kidney structure and function abnormalities. CKD also includes permanent nephron loss and a decline in glomerular filtration rate. Most CKD patients have periodon¬titis, a chronic inflammatory disease of the gums and tooth-supporting tissues. Periodontitis is linked to CKD due to the hyper-inflammatory state in both conditions. Interleukin-10 (IL-10) is an inflammatory marker with immuno¬modulatory properties influencing the host’s immune responses. Little is known regarding the effect of periodontal therapy on inflammatory markers and periodontal parameters in CKD patients with periodontitis. Therefore, this study aimed to compare the levels of IL-10 and periodontal parameters before and after receiving periodontal ther¬apy. Methods: Twenty CKD patients with periodontitis (Group 1) and twenty non-CKD patients with periodontitis (Group 2) participated in this study. A blood sample was collected during each visit. Serum IL-10 concentration was analysed using an enzyme-linked immunosorbent assay. The periodontal parameters such as periodontal probing depth, clinical attachment loss, gingival bleeding index and plaque score were also measured. Results: Our findings revealed that IL-10 level was significantly higher (p<0.05) in Group 1 [Mean (SD) = 1.301(0.29)pg/ml] than in Group 2 [Mean (SD)= 0.81(0.27)pg/ml]. Following periodontal therapy, there was a significant reduction (p<0.05) in IL-10 levels and periodontal parameters in both groups. Conclusion: Periodontal therapy has shown improvement in both inflammatory markers and periodontal parameters. IL-10 is a promising inflammatory marker for monitoring the pro¬gression of CKD. Therefore, multicentre and larger sample size studies are needed in the future

Implementation of Recommendations on the Use of Corticosteroids in Severe COVID-19

Importance: Research diversity and representativeness are paramount in building trust, generating valid biomedical knowledge, and possibly in implementing clinical guidelines. Objectives: To compare variations over time and across World Health Organization (WHO) geographic regions of corticosteroid use for treatment of severe COVID-19; secondary objectives were to evaluate the association between the timing of publication of the RECOVERY (Randomised Evaluation of COVID-19 Therapy) trial (June 2020) and the WHO guidelines for corticosteroids (September 2020) and the temporal trends observed in corticosteroid use by region and to describe the geographic distribution of the recruitment in clinical trials that informed the WHO recommendation. Design, setting, and participants: This prospective cohort study of 434 851 patients was conducted between January 31, 2020, and September 2, 2022, in 63 countries worldwide. The data were collected under the auspices of the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC)-WHO Clinical Characterisation Protocol for Severe Emerging Infections. Analyses were restricted to patients hospitalized for severe COVID-19 (a subset of the ISARIC data set). Exposure: Corticosteroid use as reported to the ISARIC-WHO Clinical Characterisation Protocol for Severe Emerging Infections. Main outcomes and measures: Number and percentage of patients hospitalized with severe COVID-19 who received corticosteroids by time period and by WHO geographic region. Results: Among 434 851 patients with confirmed severe or critical COVID-19 for whom receipt of corticosteroids could be ascertained (median [IQR] age, 61.0 [48.0-74.0] years; 53.0% male), 174 307 (40.1%) received corticosteroids during the study period. Of the participants in clinical trials that informed the guideline, 91.6% were recruited from the United Kingdom. In all regions, corticosteroid use for severe COVID-19 increased, but this increase corresponded to the timing of the RECOVERY trial (time-interruption coefficient 1.0 [95% CI, 0.9-1.2]) and WHO guideline (time-interruption coefficient 1.9 [95% CI, 1.7-2.0]) publications only in Europe. At the end of the study period, corticosteroid use for treatment of severe COVID-19 was highest in the Americas (5421 of 6095 [88.9%]; 95% CI, 87.7-90.2) and lowest in Africa (31 588 of 185 191 [17.1%]; 95% CI, 16.8-17.3). Conclusions and relevance: The results of this cohort study showed that implementation of the guidelines for use of corticosteroids in the treatment of severe COVID-19 varied geographically. Uptake of corticosteroid treatment was lower in regions with limited clinical trial involvement. Improving research diversity and representativeness may facilitate timely knowledge uptake and guideline implementation

Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms

Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4&nbsp;% presented with RS, while 13.6&nbsp;% had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7&nbsp;% vs RS: 37.5&nbsp;%). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1&nbsp;% vs. RS 32.0&nbsp;%), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83-0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders