[Effects of initial periodontal therapy on renal prognosis in patients with chronic kidney disease and periodontitis].

Objective: To investigate the effect of initial periodontal therapy on renal function related indicators in patients with chronic kidney disease (CKD) and periodontitis, with a special focus on evaluating the improvement in proteinuria and hematuria. Methods: This superiority randomized controlled trial involved 200 patients with CKD and periodontitis, recruited from May 2024 to January 2025 at the department of nephrology and referred to the Department of Stomatology at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, who were randomly assigned (1∶1) to either the intervention group (n=100) or the control group (n=100) using a computer-generated random sequence. The intervention group received standardized initial periodontal therapy, while the control group received only oral hygiene instruction. Blood and urine samples were collected from both groups at baseline and at 1, 3 and 6 months post-treatment to measure indicators including estimated glomerular filtration rate (eGFR), serum creatinine (Scr), blood urea nitrogen (BUN), uric acid (UA), bicarbonate (HCO3-), cystatin C (CysC), urinary albumin-to-creatinine ratio (UACR), urinary protein-to-creatinine ratio (UPCR), urinary creatinine (UCR), urinary microalbumin (UMA), urinary total protein (UTP), urinary red blood cell count (URBC), and dipstick results for hematuria and proteinuria. Statistical analysis followed the intention-to-treat (ITT) principle, with missing data handled by multiple imputation (MI) and analyzed using linear mixed models (LMM). P values were adjusted for multiple comparisons using the Bonferroni correction. Results: Baseline characteristics, including age, sex, body mass index (BMI), primary disease distribution, and renal laboratory parameters, were well-balanced between the two groups (P>0.05). At the 6-month primary endpoint, UACR in the intervention group was significantly better than that in the control group, with a between-group geometric mean ratio (GMR) of 0.105 (95%CI: 0.076-0.145, P<0.001). For secondary endpoints at 6 months, eGFR was significantly higher in the intervention group than in the control group, with a mean difference (MD) of 8.019 (95%CI: 4.784-11.254, P<0.001). The between-group GMRs for URBC and UPCR were 0.291 (95%CI: 0.203-0.419, P<0.001) and 0.216 (95%CI: 0.172-0.271, P<0.001), respectively. In addition, the between-group GMR of CysC at 6 months was 0.750 (95%CI: 0.681-0.827, P<0.001). No statistically significant between-group differences were observed for BUN, Scr, UA, or HCO3- during the study period (all P>0.05). Conclusions: This study demonstrates that initial periodontal therapy can effectively reduce proteinuria and hematuria in patients with CKD and periodontitis. It also has a positive impact on increasing eGFR and decreasing CysC. These findings suggest that periodontal health management could serve as a valuable adjunctive strategy in the comprehensive management of patients with CKD.