Effectiveness of Subgingival Instrumentation on Delaying End-stage Renal Disease Among Chronic Kidney Disease Patients: A Non-Randomized Clinical Study

Chronic kidney disease (CKD) is a major socio-economic and healthcare problem and represents a significant global public health challenge. The burden of disease is disproportionately higher in low- and middle-income countries. As per the Global Burden of Disease (GBD) 2023 estimates, approximately 788 million people were affected by CKD globally, with a global age-adjusted prevalence of 14.2% among adults aged 20 years and older. CKD has a significant global burden, affecting over 9% of the world population and was directly responsible for 1.2 million deaths worldwide in 2017 alone.

Chronic kidney disease is defined as the presence of kidney damage or an estimated glomerular filtration rate (eGFR) of less than 60 ml/min/1.73 m² persisting for three months or more, irrespective of the underlying cause. It represents a state of progressive loss of kidney function, ultimately resulting in the need for renal replacement therapy in the form of dialysis or kidney transplantation. Kidney damage refers to pathological abnormalities detected by imaging or renal biopsy, abnormalities in urinary sediment, or increased urinary albumin excretion rates.

The leading cause of CKD is diabetes mellitus, followed by hypertension and glomerular diseases. The prevalence of individuals with CKD due to type 1 diabetes has continued to increase globally, rising by 21.7% between 2007 and 2017 and reaching approximately 3.2 million individuals in 2017. These individuals are at increased risk of cardiovascular complications, and nearly 25-30% progress to kidney failure. Irrespective of the initial nephropathy, once a critical mass of nephrons is lost, kidney disease generally follows a progressive course toward advanced stages, resulting in increased morbidity and mortality.

The burden of CKD arises not only from the management of end-stage renal disease but also from complications related to CKD and its associated comorbidities. There are effective strategies to reduce the rate of CKD progression and improve patient outcomes; therefore, the need for therapies aimed at slowing disease progression is critical.

Periodontal bacteria, which cause chronic inflammation and the breakdown of tooth-supporting structures, are the cause of periodontal disease, a chronic infectious oral illness. One of the most prevalent oral illnesses worldwide is periodontitis, affecting almost 20-50% of the global population in varying degrees, and the percentage rises with advancing age. In India, 51% of people had periodontal disease overall. Periodontal disease is implicated as an independent risk factor for CKD. Periodontitis is defined as an inflammatory disease of the supporting tissues of the teeth caused by specific microorganisms or groups of microorganisms, resulting in progressive destruction of the periodontal ligament and alveolar bone, with periodontal pocket formation, gingival recession, or both.