To Predict Diabetic Nephropathy, First Look at Gums

Patients with type 2 diabetes who have periodontitis are more likely than other diabetic patients to develop kidney disease, including end-stage renal failure. What remains unclear, however, is whether treating the periodontitis reduces the risk of developing diabetic nephropathy later on.

Periodontitis left unchecked can lead to systemic physiological changes, and the main culprit appears to be inflammation in tissue surrounding the gums.¹ “Both periodontitis and kidney disease are associated with inflammatory markers such as C-reactive protein, and chronic low inflammation levels associated with periodontitis could lead to endothelial dysfunction, which plays a role in the pathogenesis of kidney disease,” explains Wendy Shultis, PhD, lead researcher and author in the Phoenix branch of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a branch of the National Institutes of Health. Shultis proposes that the link between gum disease and the subsequent development of kidney disease is inflammation.

Shultis and other researchers studied the relationship between periodontitis and nephropathy among 529 members of the Gila River Indian Community in Arizona. At the beginning of the study, all the individuals were ≥25 years; 20% had no periodontitis or a mild condition, 38% had moderate periodontitis, 22% had severe periodontitis, and 20% were toothless. A total of 193 participants showed signs of kidney disease within a follow-up period lasting >9 years, and 68 participants had developed end-stage renal disease 14.9 years into the study, researchers conclude.²

“Moderate and severe periodontitis as well as having no teeth predicted the development of nephropathy,” says Shultis. Compared with subjects with no periodontitis or a mild condition, individuals with moderate gum disease had twice the risk of developing kidney disease, those with severe gum disease had 2.1 times the risk, and participants who were toothless had 2.6 times the risk, according to Shultis.

Diabetes is the primary cause of kidney failure in the U.S., according to the National Kidney Foundation. Additionally, almost half (45%) of new patients starting dialysis each year in the U.S. are patients with diabetes, the foundation notes. ▪

Periodontitis Signs and Symptoms

Screen patients with type 2 diabetes by examining for or asking about the following symptoms:

1. Gums that bleed during or after toothbrushing

2. Red, swollen, or tender gums

3. Persistent bad breath or bad taste in mouth

4. Receding gums

5. Formation of deep pockets between teeth and gums

6. Loose or shifting teeth

7. Changes in the way teeth, partial plates, or dentures fit together when biting

Source: Fighting gum disease: How to keep your teeth. Available online at www.fda.gov/Fdac/features/2002/302_gums.html. Accessed April 3, 2007.