Correlation Between Periodontal Disease And Diabetic Nephropathy In Patients With Type2Diabetes

There was a closely relationship between Periodontal disease and Diabetes mellitus. Recent reseraches had revealed that the periodontal disease not only went against glycemic control of diatetes, but also might correlate with diabetic complication,especially with the Diabetic nephropathy (DN). The diabetic patients with severe periodontal disease were at greater risk of mortality from ischemic heart disease and diabetic nephropathy. While other reserachers thought the relationship was not confirmed without ruled out the risk factors. In this reserch,we intended to furture disscuse the correlationship between periodontal disease and DN from the epidemiological investigation, with ruling out all the possible risk factors.We expected to provide new ideas for the early detection of DN according to the periodontal status of diabetic patients, so as to give the patients early prevention and treatment.Nevertheless, when DN progress to the late stage, there were no effective measures to control, but only some patients progress to the end stage renal disease (ESRD). The main treatment methods were blood purification (hemodialysis, peritoneal dialysis) and renal transplantation currently, but most patients could only receive dialysis treatment with various limitions. Hemodialysis could significantly improve the quality of life, maintain life and prepare for renal transplantation. Researches had shown that periodontal disease might increase the inflammation load of ESRD, leading to serious heart cerebrovascular complications and adverse events appeared. So, it was very important for dialysis patients to closely monitor and maintain oral health. Nowadays a lot of researchs on the oral health of dialysis patients had been made, but there was no conclusion, and most of researches were focused on chronic kidney disease, with rarely on DN. Other studies showed the severity of periodontal disease was progress with the treatment of chronic kidney disease, when compared with pre-dialysis and dialysis treatment, indicating that periodontal disease might play a role in the progression of chronic kidney disease. At present, whether the periodontal disease also played a role in the progression of DN, there was no related report. Objective1. To furture explore the correlationship between periodontal disease and DN by ruling out all the possible risk factors.2.To investigate the oral health status of maintenance hemodialysis patients, and compare with other stages of DN patients, so as to discribe the role of periodontal disease in the progression of DN.Methods1.200new hospitalized patients with type2diabetes were enrolled. Subjects were further divided into three groups according to the level of microalbuminuria(MAU): A group (normal albuminuria group):MAU<30mg/24h, B group (early-stage DN group):MAU:30～300mg/24h, C group (clinical DN group):MAU>300mg/24h. The clinical data and kidney function markers including serum creatinine (Scr),blood urea nitrogen(BUN) were collected, estimated glomerular filtration rate(eGFR) were calculated and the periodontal conditions including the periodontal pocket depth (PD), bleeding index (BI), attachment loss(AL) and tooth loss were detected.2.32Maintenance hemodialysis patients were enrolled. The clinical and periodontal data were collected(as above), and age-and gender-matched with the above patient. Subjects were further divided into three groups according to the progression of DN:A group:normal albuminuria group (as above), B group:predialysis group(including early-stage and clinical DN group), C group:hemodialysis group. Comparing the differences between groups.Results1. BI,PD,AL and tooth loss were increasing with MAU (P<0.001). Logistic analysis showed that PD, GI and AL were the independent risk factors of DN(P<0.05or0.01). Scr was positively correlative with BI,PD,AL and tooth loss(r=0.2、0.267、0.324、0.316respectively, P<0.01);BUN was positively correlated with BI,PD,AL and tooth loss (r=0.147,0.168,0.268,0.334respectively, P<0.05) and eGFR was not correlated with BI(r=-0.137,P>0.05), but negatively correlated with PD,AL and tooth loss(r=-0.213,-0.284,-0.339respectively, P<0.01).2.Compared with normal proteinuria group, predialysis and hemodialysis patients had significantly worse dental status regarding to BI, PD, AL and missing teeth number(P<0.05or0.01), and the incidence of retinopathy, coronary heart disease, cerebral infarction and hypertension was also increased. There was no differece between predialysis and hemodialysis patients in BI, PD and AL, but the dialysis patients lost significantly more teeth(P<0.05). For hemodialysis patients the level of hsCRP was higher compared with normal proteinuria and predialysis group(P<0.05).Conclusion1.There might be a close correlation between periodontal disease and DN. The periodontal disease and tooth loss could be an indicator for early detection of DN. In addition, periodontal disease might cause kidney disease occur by affecting renal function.2. Hemodialysis patients had significantly worse periodontal status. The role of periodontal disease in the progression of DN, still needed to be verified by large sample and multicenter clinical trials.