Effect of periodontal therapy on the systemic inflammation and metabolic markers in patients undergoing hemodialysis or/and peritoneal dialysis: a systematic review and meta-analysis
Abstract Background: This systematic review aimed to investigate whether periodontal treatment can reduce the systemic inflammatory levels and improve the metabolic levels in patients undergoing hemodialysis (HD) or/and peritoneal dialysis (PD). Methods: Electronic databases (PubMed, EMBASE, CENTRAL, NCKI, and WFPD) were searched up to July 2019. The risk of bias within studies was assessed through the Cochrane Collaboration' s risk assessment tool. The systemic inflammatory and metabolic measures were the highly sensitive C-reactive protein (hs-CRP), interleukin 6 (IL-6), tumor necrosis factor-α (TNF-a), the albumin (Alb), and lipid metabolic levels. Meta-analyses (MAs) were performed to calculate the overall effect size where appropriate. Results: Five studies were eligible for this systematic review. The result of four studies revealed a significant difference in the CRP level after periodontal treatment in patients receiving HD or/and PD. Two studies reported the IL-6 and the Alb level after periodontal treatment but revealed no significant difference. No MAs could be performed on the TNF- a level and the lipid metabolic markers. Conclusions: Periodontal treatment may moderately reduce the serum of CRP levels in HD or/and PD patients. For the TNF-a, IL-6, Alb levels and lipid metabolic markers, no sufficient evidence supports the difference after periodontal treatment. Therefore, larger scales and high-quality randomized-controlled trials (RCTs) are required to assess the effect of periodontal treatment on systemic inflammatory and metabolic parameters in HD or/and PD patients.