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The goal of this observational study is to investigate the relationship between chronic kidney disease (CKD) and periodontitis, and to evaluate the potential mediating role of dietary inflammatory potential, measured by the Dietary Inflammatory Index (DII), in this association.
The main question it aims to answer is:
Does a pro-inflammatory diet, as reflected by a higher DII score, exacerbate periodontal inflammation in individuals with chronic kidney disease?
Participants will include adults diagnosed with CKD at various stages. Periodontal status will be assessed through clinical parameters such as probing depth, clinical attachment loss, and bleeding on probing. Dietary intake will be evaluated using a validated food frequency questionnaire, and DII scores will be calculated accordingly. The study will aim to observe and analyze whether dietary inflammation contributes to increased periodontal disease severity in CKD patients, potentially offering insight into modifiable risk factors relevant to both systemic and oral health.
This observational study will aim to investigate the association between chronic kidney disease (CKD) and periodontitis, with a specific focus on the potential role of dietary inflammatory potential measured by the Dietary Inflammatory Index (DII). Adult participants diagnosed with CKD will be enrolled and their periodontal status will be evaluated using standard clinical parameters, including plaque index, probing depth, clinical attachment loss, and bleeding on probing. Dietary intake data will be collected through a validated food frequency questionnaire, and individual DII scores will be calculated to estimate the inflammatory potential of each participant's diet. The study will analyze whether higher dietary inflammatory load is associated with increased periodontal disease severity in individuals with CKD. Findings from this study are expected to contribute to a better understanding of the interplay between systemic disease, oral health, and modifiable lifestyle factors such as diet.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Patients diagnosed with chronic kidney disease | Chronic kidney disease is diagnosed if the eGFR is below 60 ml/min/1.73 m2 for at least 3 months or if the urine albumin-creatinine ratio is above 30 mg/g (proteinuria). |
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| Measure | Description | Time Frame |
|---|---|---|
| Dietary Inflammatory Index | The Dietary Inflammatory Index (DII) provides a score that measures the potential for a person's diet to cause inflammation in the body. This index is based on the pro- or anti-inflammatory effects of consumed foods and nutrients. Participants' 3-day food intake records will be entered into the system, and average daily energy intake, macronutrients, and micronutrients will be calculated. Based on the food records, average daily intake of 36 nutrients will be determined, and DII scores will be derived from these nutrient parameters. A lower score indicates a more antiinflammatory diet, while a higher score indicates a more proinflammatory diet. | Day 1 |
| Measure | Description | Time Frame |
|---|---|---|
| Clinical Periodontal Parameters (Plaque Index) | Plaque Index (PI) (Silness and Löe, 1964) This index is used to evaluate the amount of dental plaque accumulation on tooth surfaces. Each tooth's four surfaces (buccal, lingual, mesial, distal) are examined using a probe or visually. Each surface is scored from 0 to 3. The average score is calculated for each tooth. The overall plaque index is obtained by averaging the scores from all examined teeth. Score Description 0 No plaque.
|
| Measure | Description | Time Frame |
|---|---|---|
| Creatinine | Creatinine is a waste product generated from muscle metabolism and excreted by the kidneys; its serum level is used to assess renal function. | Day 1 |
| Albumin | Albumin is the main serum protein synthesized by the liver that maintains plasma oncotic pressure; it provides information about nutritional status and kidney function. |
Inclusion Criteria:
Exclusion Criteria:
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Patients diagnosed with chronic kidney disease who come to the Periodontology Clinic of Recep Tayyip Erdoğan University Faculty of Dentistry for routine periodontal treatment
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Oguz KOSE, Professor Dr. | Contact | +90 541 348 64 65 | oguz.kose@erdogan.edu.tr |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Department of Periodontology of the Faculty of Dentistry of Recep Tayyip Erdogan University | Rize | Rize Province | 53200 | Turkey (Türkiye) |
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| ID | Term |
|---|---|
| D051436 | Renal Insufficiency, Chronic |
| D010518 | Periodontitis |
| D007249 | Inflammation |
| ID | Term |
|---|---|
| D051437 | Renal Insufficiency |
| D007674 | Kidney Diseases |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
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Serum blood samples Routine blood tests will include biomarkers such as creatinine, albumin, blood urea nitrogen, GFR, hsCRP, vitamin D, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), uric acid, ferritin, iron, phosphorus, calcium, and parathyroid hormone. The spot urine albumin-to-creatinine ratio (ACR) will be recorded.
| Day 1 |
| Clinical Periodontal Parameters (Gingival Index) | The Gingival Index is used to assess the presence and severity of gingival inflammation (gingivitis). Four surfaces of each tooth (buccal, lingual, mesial, distal) are examined visually and with a periodontal probe. The evaluation considers color changes, edema (swelling), tissue consistency, and bleeding on probing. Each surface is scored from 0 to 3. The average score per tooth is calculated, and then the overall average is used to determine the individual's GI score. Score Description 0 Healthy gingiva: normal color and texture, no bleeding
| Day 1 |
| Periodontal Clinical Parametres (Bleeding on Probing Index) | This index is used to assess the presence and severity of gingival inflammation by observing bleeding after gentle pressure is applied to the gingival sulcus using a periodontal probe. A thin periodontal probe is gently inserted into the gingival sulcus with light pressure (approximately 20-25 grams). Bleeding occurring within 10-30 seconds is observed. Each measurement site is recorded as either "bleeding present" or "bleeding absent." Presence of bleeding is an early and sensitive indicator of gingival inflammation. Score Description: 0 No bleeding 1 Bleeding present (mild or severe) | Day 1 |
| Periodontal Clinical Parametres (Probing Pocket Depth) | Using a Williams periodontal probe, the distance between the gingival margin and the base of the periodontal pocket is measured in millimeters at six sites per tooth: mesiobuccal, midbuccal, distobuccal, mesiolingual, midlingual, and distolingual. All teeth are measured. The values obtained from each site are summed and then divided by the total number of sites measured. This gives the average probing depth for the individual. Measurement Interpretation 1-3 mm Healthy sulcus 4-5 mm Shallow to moderate pocket ≥6 mm Deep periodontal pocket (advanced disease) | Day 1 |
| Periodontal Clinical Parametres (Clinical Attachment Loss) | Using a Williams periodontal probe, the distance between the enamel-cementum junction and the base of the periodontal pocket is measured in millimeters at six sites per tooth: mesiobuccal, midbuccal, distobuccal, mesiolingual, midlingual, and distolingual. All teeth are measured. The values obtained from each site are summed and then divided by the total number of sites measured. This gives the average probing depth for the individual. CAL Value Interpretation 0-1 mm Healthy / minimal loss 2-3 mm Mild attachment loss 4-5 mm Moderate attachment loss ≥6 mm Severe attachment loss | Day 1 |
| Day 1 |
| Blood urea nitrogen | Blood urea nitrogen (BUN) represents the amount of nitrogen in the blood derived from urea, a byproduct of protein metabolism, and is an indicator of renal function. | Day 1 |
| Glomerular filtration rate | Glomerular filtration rate (GFR) indicates the volume of blood filtered by the kidneys per minute and is a key parameter for evaluating renal function. | Day 1 |
| High-sensitivity C-reactive protein | High-sensitivity C-reactive protein (hsCRP) is a sensitive marker used to detect low-grade systemic inflammation. | Day 1 |
| Vitamin D | Vitamin D is a fat-soluble vitamin that regulates calcium-phosphorus metabolism and plays a role in bone health and immune function. | Day 1 |
| Uric acid | Uric acid is the end product of purine metabolism, and elevated levels are associated with gout and kidney disease. | Day 1 |
| Ferritin | Ferritin is a protein responsible for iron storage in the body, and its serum level reflects iron stores. | Day 1 |
| Iron | Iron is an essential trace element involved in hemoglobin synthesis and oxygen transport. | Day 1 |
| Phosphorus | Phosphorus is an essential mineral involved in bone mineralization and cellular energy metabolism. | Day 1 |
| Calcium | Calcium is a vital mineral required for bone and dental health, muscle contraction, and nerve transmission. | Day 1 |
| Parathyroid hormone | Parathyroid hormone (PTH) is a hormone secreted by the parathyroid glands that regulates calcium and phosphorus balance. | Day 1 |
| Platelet | Platelets are anucleate blood cell fragments derived from megakaryocytes in the bone marrow, and their primary function is to participate in blood clot formation (hemostasis) to prevent bleeding. | Day 1 |
| Lymphocyte | Lymphocytes are key cells of the adaptive immune system and mainly consist of T cells, B cells, and natural killer (NK) cells; they generate specific immune responses against infections and foreign antigens. | Day 1 |
| Neutrophil | Neutrophils are the most abundant leukocytes in the innate immune system and constitute the first line of defense against bacterial infections by destroying microorganisms through phagocytosis. | Day 1 |
| D005261 |
| Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |
| D002908 | Chronic Disease |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010510 | Periodontal Diseases |
| D009059 | Mouth Diseases |
| D009057 | Stomatognathic Diseases |