Impact of Red Complex Bacteria and TNF-α Levels on the Diabetic and Renal Status of Chronic Kidney Disease Patients in the Presence and Absence of Periodontitis
Jaideep Mahendra,
Plato Palathingal,
Little Mahendra,
Khalid J. Alzahrani,
Hamsa Jameel Banjer,
Khalaf F. Alsharif,
Ibrahim Faisal Halawani,
Janani Muralidharan,
Pandapulaykal T. Annamalai,
Shyam Sankar Verma,
Vivek Sharma,
Saranya Varadarajan,
Shilpa Bhandi,
Shankargouda Patil
Affiliations
Jaideep Mahendra
Department of Periodontics, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Greater Education and Research, Chennai 600095, India
Plato Palathingal
Department of Periodontics, PSM College of Dental Science and Research, Thrissur 680519, India
Little Mahendra
Department of Periodontics, Dean, Maktoum Bin Hamdan Dental University, Dubai 122002, United Arab Emirates
Khalid J. Alzahrani
Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
Hamsa Jameel Banjer
Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
Khalaf F. Alsharif
Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
Ibrahim Faisal Halawani
Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
Janani Muralidharan
Department of Periodontics, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Greater Education and Research, Chennai 600095, India
Pandapulaykal T. Annamalai
Department of Biochemistry, Jubilee Medical College Hospital, Thrissur 680005, India
Shyam Sankar Verma
Department of Nephrology, Jubilee Medical College Hospital, Thrissur 680005, India
Vivek Sharma
Department of Periodontics, Desh Bhagat Dental College and Hospital, Mandi Gobindgarh 114141, India
Saranya Varadarajan
Department of Oral Pathology and Microbiology, Sri Venkateswara Dental College and Hospital, Chennai 600130, India
Shilpa Bhandi
Department of Restorative Dental Sciences, Division of Operative Dentistry, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
Shankargouda Patil
Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan 45412, Saudi Arabia
Scientific evidence shows a positive association in the etiopathogenesis of periodontitis and chronic kidney disease (CKD). Various confounding factors, such as obesity, diabetes, and inflammation, also play a significant role in the progression of CKD, which remains unexplored. We hypothesise the role of red complex bacteria with various confounding factors associated with chronic kidney disease. The study comprised a total of 120 participants categorised into 4 groups: the control group (C), periodontitis subjects without CKD (P), periodontally healthy chronic kidney disease subjects (CKD), and subjects having both periodontitis and CKD (P + CKD), with 30 subjects in each group. Demographic variables, and periodontal, renal, and diabetic parameters were recorded. Tumour necrosis factor (TNF)-α levels and those of red complex bacteria such as Prophyromonas gingivalis (P.g), Treponema denticola (T.d), and Tonerella forsythia (T.f) were assessed, and the obtained results were statistically analysed. Among the various demographic variables, age showed a level of significance. Mean PI, GI, CAL, and PPD (the proportion of sites with PPD ≥ 5 mm and CAL ≥ 3 mm) were elevated in the P + CKD group. Diabetic parameters such as fasting blood sugar (FBS) and HbA1c levels were also greater in the P + CKD group. Renal parameters such as eGFR and serum creatinine levels were greater in CKD patients. The estimation of red complex periodontal pathogens such as Pg, Td and Tf levels were significantly greater in the P and P + CKD groups. Pearson correlation analysis revealed significant correlation of red complex bacteria with all variables. Greater levels of P.g, T.d and T.f were found in the P groups, thus indicating their important role in the initiation and progression of inflammation of periodontitis and CKD, with diabetes as one of the confounding factors. The study also confirmed a log-linear relationship between TNF-α levels and red complex bacteria, thereby demonstrating the role of inflammatory biomarkers in periodontal disease progression that could contribute to the development of systemic inflammation such as CKD.
