Oxidative stress links periodontal inflammation and renal function

Praveen Sharma, Anthony Fenton, Irundika HK Dias, Brenda Heaton, Caroline LR Brown, Amneet Sidhu, Mutahir Rahman, Helen R. Griffiths, Paul Cockwell, Charles J. Ferro, Iain L. Chapple, Thomas Dietrich

Research output: Contribution to journalArticlepeer-review


Aims: Patients with chronic kidney disease (CKD) are also susceptible to periodontitis. The causal link between periodontitis and CKD may be mediated via systemic inflammation/oxidative stress. Using structural equation modelling (SEM), this cross-sectional study aimed to explore the causal relationship between periodontal inflammation (PI) and renal function. Materials and methods: Baseline data on 770 patients with stage 3–5 (pre-dialysis) CKD from an ongoing cohort study were used. Detailed, bioclinical data on PI and renal function, as well as potential confounders and mediators of the relationship between the two, were collected. SEMs of increasing complexity were created to test the causal assumption that PI affects renal function and vice versa. Results: Structural equation modelling confirmed the assumption that PI and renal function are causally linked, mediated by systemic oxidative stress. The magnitude of this effect was such that a 10% increase in PI resulted in a 3.0% decrease in renal function and a 10% decrease in renal function resulted in a 25% increase in PI. Conclusions: Periodontal inflammation represents an occult source of oxidative stress in patients with CKD. Further clinical studies are needed to confirm whether periodontal therapy, as a non-pharmacological approach to reducing systemic inflammatory/oxidative stress burden, can improve outcomes in CKD.

Original languageEnglish
Pages (from-to)357-367
Number of pages11
JournalJournal of Clinical Periodontology
Issue number3
Early online date27 Dec 2020
Publication statusPublished - Mar 2021

Bibliographical note

© 2020 The Authors. Journal of Clinical Periodontology published by John Wiley & Sons Ltd.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.


  • chronic kidney disease
  • inflammation
  • oxidative stress
  • periodontitis
  • structural equation modelling


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