Association between periodontitis and its treatment on mortality rates of end-stage renal disease: A systematic review and meta-analysis

Background: The association between periodontitis and systemic diseases is widely researched. Conflicting literature exists on the relationship between periodontitis and the outcomes of end -stage renal disease (ESRD) patients. We hereby reviewed evidence to examine if periodontitis and its management impact the mortality rates of ESRD patients. Material and Methods: Literature was searched on the databases of PubMed, Embase, CENTRAL, Web of Science, and Scopus till 27th April 2023. All cohort studies reporting adjusted effect size of the relationship between periodontitis or its management and mortality rates of ESRD patients were included. Results: Eight studies were eligible of which six reported the association between periodontitis and mortality while two reported between periodontal treatment and mortality. Pooled analysis showed no association between the presence of periodontitis and all -cause mortality amongst ESRD patients (HR: 1.13 95% CI: 0.77, 1.65 I2=72%). Results were unchanged on sensitivity analysis. Pooled analysis of three studies showed no difference in the risk of cardiovascular mortality amongst ESRD patients with and without periodontitis (HR: 1.44 95% CI: 0.57, 3.60 I2=86%). A descriptive analysis of two studies showed that periodontal treatment could reduce the risk of mortality in ESRD patients with periodontitis. Conclusions: Limited evidence indicates that periodontitis does not impact all -cause and cardiovascular mortality in ESRD patients. Data on the role of periodontal therapy in improving outcomes is scarce. Further research is needed to generate high -quality evidence on this subject.