Chronic ml/min per 1.73m2), according to the Kidney

Chronic kidney disease (CKD) is a
major health problem and defined as either kidney damage in term of structural
or functional or a decreased glomerular filtration rate (below 60 ml/min per
1.73m2), according to the Kidney Disease Outcomes Quality Initiative
guidelines. The guidelines developed by the National Kidney Foundation’s Kidney
Disease and Outcomes Quality Initiative (K/DOQI) defined five stages of CKD
based on different ranges of GFR: stage 1, GFR >90 mL/min/1.73m2;
stage 2, GFR 60 to 89 mL/min/1.73m2; stage 3a, GFR 45 to 59
mL/min/1.73m2; stage 3b, GFR 30 to 44 mL/min/1.73m2;
stage 4, GFR 15 to 29 mL/min/1.73m2; stage 5, GFR <15 mL/min/1.73m2.   In worldwide, the prevalence of CKD and end-stage renal disease (ESRD) is increasing. The estimated prevalence of CKD in the US was 16.8% while in Asia the prevalence ranged from 12.1% to 17.5%. In Malaysia, the incidence and prevalence of patients with ESRD on dialysis had increased from 88 and 325 per million population (pmp) respectively in 2001 to 170 and 762 pmp respectively in 2009. (CPG MOH, 2011)   The common causes for CKD are hypertension, diabetes mellitus, chronic glomerulonephritis, obstructive neuropathy, autoimmune disease and obesity (Ausavarungnirun R et al., 2016). The clinical signs and symptoms of chronic kidney disease are dependent on the stage of disease, affect most body systems, and are collectively called uremia. (Caroline Perozini et al., 2017)   CKD patients are known to be in state of uremia due to limitation or reduction of the ability of the kidney to filter then subsequently causes increase of toxic substances in the bloodstream. This is accompanied by altered immune system because of impaired of T- and B-lymphocytes as well as monocytes and macrophages (Girdt M et al., 2001) resulting in a decreased host response to the subgingival Gram-negative microbial aggression; uremia might also be accounted as association of increased prevalence and severity of gingival inflammation and periodontitis with increased dialysis vintage (Castillo A et al., 2007).   Periodontitis is a chronic inflammatory disease that leads to the destruction of periodontal tissue. This process is characterized by a pocket formation around teeth and/or gum recession (Armitage GC, 1999). This disease is known by destruction of periodontal tissues by periodontal pathogens resulting in detachment of tissues from around the teeth and the entry of pathogens and their products into systemic circulation leading to the increase systemic inflammation (Loos BG, 2006). The mechanism proposed for the effect of periodontitis on progression of kidney disease is systemic inflammation (Barconez-Martinez A et al., 2009).   Studies found that both periodontitis and kidney diseases are associated with inflammatory markers such as C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor (Rahmati MA et al., 2002). A study by Vilela at al reported that the reduction of IL-6 and hs- CRP in both CKD and control patients following periodontal treatment. Thus, effective management of periodontitis in this population can improve systemic inflammation and slower the progression of renal disease. Moreover, it may lower the risk of associated systemic complication.   To enable effective planning of oral health intervention for CKD patients, it is necessary to have information on the prevalence and severity of periodontitis in this population, Moreover, there is no report available in Malaysia regarding periodontal status in pre-dialysis CKD patient at different stages. With highlight of this issue, findings from this study may be used as a baseline data on periodontal status in pre-dialysis CKD patients in Malaysia. Pre-dialysis CKD patients are considered at high periodontal risk and susceptible to oral diseases will be referred for further dental management. Besides, oral health care team can deliver current preventive methods and materials to this population.   Therefore, this study aims to determine the periodontal severity among pre-dialysis CKD patients at different stages in HUSM, Kelantan, Malaysia. Furthermore, the purpose of this study to provide guidance for dental and medical professionals in focusing on prevention of oral diseases and ensuring that dental services are of high quality and responsive to the needs of CKD patients.


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