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Abstract
Chronic kidney disease incidence have been rising since the publication of the practical guidelines by the Kidney Disease Outcomes Quality Initiation (KDOQI) of the National Kidney Foundation (NKF) in 2002 to reach 200 case per million in many countries around the world with survival rate 3 to 5 years. There are many mechanisms by which chronic kidney disease can affect the oral cavity; uremia, hyperparathyroid hormone, anemia, oxidative stress and and the dramatic rise in inflammatory mediators such as IL-1, IL-6,TNF-α, CRP and MCP-1. The oral mucosa, salivary glands, teeth and even periodontal tissues all are affected by the disease.Complications of chronic kidney disease could be prevented if the condition was early detected and controlled; metabolic complications and cardiovascular complication are the most serious complications of chronic kidney disease; both can be early detected and controlled. One successful approach to control the complications is to monitor the inflammatory mediators such as MCP-1a key chemokine; its increasing level translates the decline in renal function and predates the onset of its serious complications.
Subjects and methods: The current study was conducted on 50 individuals divided into 4 groups Group 1(15 with a GFR 59-30 ml/min/1.73 m2 “Stage3 CKD”), Group 2 (15 with a GFR 29-15 ml/min/1.73 m2 “Stage 4 CKD”), Group3 (diseased control group, 10 individuals with chronic moderate to severe periodontitis), Group 4: control group, consists of 10 individuals, these patients were selected to be medically free. All groups were subjected to full history, detailed oral examination and salivary sampling.
Results: The salivary MCP-1 values were higher in stage 4 CKD or the late stage (464± 84.7 pg/ ml), a relatively decreased salivary flow rate was found in stage 4 CKD which was (0.8± 0.06 ml/ min). Periodontal disease was higher in stage 4 CKD patients. The gingival index percentage; stage 4 CKD had the significantly higher percentage (95%), the plaque index results showed that the percentage of teeth surfaces with moderate to severe plaque accumulation was significantly higher in stage 4 CKD (94.9%), the clinical attachment level results showed that the percentage of surfaces with moderate to severe periodontitis was (87.6%), patients in stage 4 had the higher DMFT (24.4± 4.5).
Conclusion: The MCP-1 values was higher in the salivary samples of patients with chronic kidney disease stage 4 (late stage) than stage 3 (early stage) and the MCP-1 values was higher in both stages compared to both control group. The salivary MCP-1values inversely correlate with the GFR. The dental condition was worsen in chronic kidney disease patients when compared to chronic periodontitis and healthy control groups. A direct proportional relation was found between the DMFT index and the salivary MCP-1 values.