Relação entre condição periodontal, marcadores do metabolismo glicêmico e parâmetros bioquímicos e hematológicos em pacientes transplantados renais

Abstract

The high prevalence of periodontal disease in individuals with chronic kidney disease has been consistently reported in the literature. Evidence has reinforced that there is a possible relationship between periodontal inflammation and systemic changes in chronic kidney disease patients. However, there was a lack of intervention studies that aim to analyze whether there is an impact of non-surgical periodontal therapy (NSPT) on these systemic markers. Thus, the present thesis had the following objectives: [1] to investigate the relationship between the periodontal status and markers of the glycemic level in kidney transplant recipients; and [2] to analyze the effect of NSPT on clinical outcomes and serum markers of individuals after kidney transplantation (KTx). This thesis consists of two chapters. In the first one, the objective was to investigate the relationship between periodontal condition and hyperglycemia in patients after KTx, through a cross-sectional study that analyzed 44 kidney transplant patients, 25 men and 19 women with a median age of 43 years. The severity of periodontitis was categorized into stages I to IV and hyperglycemia was analyzed at different fasting blood glucose (FBG) cutoff points (100 mg/dL, 110 mg/dL, 120 mg/dL, 126 mg/dL, 140 mg/dL). Age, smoking history, previous type 2 diabetes mellitus (DM2) and previous cardiovascular disease (CVD) were considered cofactors. Multivariate logistic regression modeling was performed with periodontitis as exposure and hyperglycemia as outcome. Pathway analysis was performed with the FBG as a continuous outcome. As results, it was observed that patients with periodontitis had increased odds of hyperglycemia from 120 mg/dL FBG cutoff in KTx recipients, even after adjustments. Additionally, periodontitis severity was positively associated with FBG level (β = 0.323, SE = 0.127, P = 0.011) in KTx recipients. These findings suggest that periodontitis may be related to increased hyperglycemia and FBG levels in KTx patients. The second chapter presents an intervention study, carried out with 20 kidney transplant patients (9 women and 11 men, with an average age of 44.4 years), which aimed to analyze the effect of NSPT on white blood cell (WBC) count, fasting blood glucose, hemoglobin, hematocrit, creatinine and uric acid in these patients. Periodontal and serum data collection was performed at baseline (before NSPT) and 90 days after NSPT. Periodontal assessment included: Probing Depth (PD), Clinical Attachment Level (CAL), Bleeding on Probing (BOP) and Visible Plaque Index (VPI). Patients with or without periodontitis and categorized into stages (1 to 4) according to the criteria of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Patients were classified with periodontitis when they presented interdental CAL detectable at ≥2 non-adjacent teeth, or buccal or oral CAL ≥3 mm with pocketing >3mm detectable in at least two teeth. NSPT (scaling and root planing) followed by dental polishing was performed in a single session using Gracey periodontal curettes and an ultrasound device. Delta values (Δ = 90 days after NSPT – before NSPT) were calculated. Parametric tests were included in the statistical analysis. The significance level adopted was 5%. Patients showed a reduction in the percentage of sites with PD ≥3 mm, in the percentage of sites with PD ≥4 mm and BOP 90 days after NSPT. The delta of WBC count showed a direct correlation with the percentage of sites with CAL ≥3 mm (r = 0.645, P = 0.002) and BOP (r = 0.663, P = 0.001); and the delta of uric acid showed a direct correlation with the percentage of sites with CAL ≥3 mm (r = 0.562; P = 0.010). In conclusion, NSPT seems to have an impact on the reduction of serum levels of WBC count and uric acid, suggesting a beneficial effect on systemic health in kidney transplant recipients. These results reinforce the importance of including dental care in the follow-up of these patients to maintain periodontal and systemic health.