The association between periodontal disease and serum biomarkers levels in haemodialysis patients: a narrative review

The vast majority of studies has demonstrated that periodontal infection promotes significant systemic inflammatory status. The specific effects of these systemic alterations in response to periodontal inflammation have been comprehensively described and appear to be highly stereotyped, and it is well known the pathophysiological mechanism related to immune functioning linking periodontitis and pathologies such as diabetes or cardiovascular diseases, adverse pregnancy outcomes, and rheumatoid arthritis. More recently, it has been proposed that this association could be extended to consider periodontal infection as trigger to complications in maintenance haemodialysis (HD) patients through the establishment of inflammatory status in association to impaired nutritional status, emphasizing the role of periodontal infection in increase of C-reactive protein serum marker, a notably predictor of the cardiovascular risk. The aim of this narrative review was to summarize the currently literature evidence that has developed around the potential impact of periodontal inflammatory status on serum nutritional and inflammatory biomarkers concentration monitoring the severity of systemic conditions in HD patients, in which cardiovascular events and malnutrition are the most common causes of mortality and morbidity. Methods: an electronic PubMed, Google Scholar and Cochrane database search complemented by a manual search of the bibliographies cited in all identified articles was performed between 2012 and 2019. The inclusion criteria were: all types of articles, articles published in PubMed, , Google Scholar and Cochrane and related only to humans. The exclusion criteria were: articles for which full text was not available, were not in English, or were grey literature. Keywords set: hemodialisys serum markers and periodontitis have been combined through the use of Mesh search. The terms then inserted in Pubmed were “serum markers”, “hemodialisys”, “periodontal disease” OR “periodontal infection” OR “periodontal inflammation”. Results: thirteen articles were identified. Studies currently available on the impact of periodontitis on the serum markers level in HD patients are analogous. Results confirmed the impact of subclinical inflammation related to periodontitis on C-reactive protein and albumin serum levels, supporting the emerging hypothesis of relationship between periodontal infection and HD status. Conclusions: although many studies have suggested that the inflammatory cytokines release may play a key role in several clinical alterations related to HD maintenance, further studies are needed to investigate the long-term consequences of chronic inflammation caused by periodontitis. There is a paucity of data concerning to the impact of periodontal disease on maintenance hemodialysis patients and about mechanisms involved.