Awareness, perceptions, and clinical practice approaches of nephrologists toward the periodontal disease–chronic kidney disease association

Year 2026, Volume: 9 Issue: 2 , 544 - 551 , 12.03.2026

Seval Ceylan Şen , Özlem Saraç Atagün , Gülbahar Ustaoğlu , Tuğçe Paksoy , Meral Gülay Kadıoğlu Koçak

https://doi.org/10.32322/jhsm.1851652

https://izlik.org/JA23JA46AM

Abstract

Aims: Periodontitis is a chronic inflammatory condition implicated in the pathogenesis of systemic diseases, including chronic kidney disease (CKD), primarily through low-grade systemic inflammatory pathways. Given the potential impact of periodontal health on CKD progression, this study aims to assess nephrologists’ awareness, attitudes, and clinical practices regarding the association between periodontal disease and CKD.
Methods: This cross-sectional study used a structured, literature-based questionnaire distributed via Google Forms to nephrologists. Participation was voluntary, and informed consent was obtained online. The survey included demographic questions and items assessing awareness, attitudes, and clinical practice approaches regarding the interrelationship between periodontal disease and CKD. A total of 144 nephrologists completed the survey. Multivariable binary logistic regression was employed to identify independent predictors of participants' oral health education status.
Results: Of the 144 nephrologists surveyed, most were aged 45–54 years, had 11–20 years of experience, and worked in university hospitals following over 100 CKD patients monthly. While general awareness of the oral–renal connection was moderate to high, many participants did not routinely take oral health histories or recognize uremic manifestations. Nonetheless, the majority reported referring patients with oral complaints to dentists. Prior training in oral health and recent dental visits were associated with higher awareness and more positive attitudes. Regression analysis identified age as a significant predictor of prior training, with nephrologists aged 35–44 and 55+ being 7.4 times more likely to have received oral health education (p=0.036).
Conclusion: Since age was identified as a significant predictor of prior training, with younger nephrologists being less likely to have received oral health education, targeted interdisciplinary programs focusing on early-career specialists are essential to bridge this knowledge gap. Furthermore, the inverse relationship between educational opinions and prior training emphasizes a strong perceived need for such interventions among untrained professionals.

Keywords

Periodontitis , chronic kidney disease , nephrologists , awareness , survey

Ethical Statement

This questionnaire-based study was approved by the Hamidiye Non-Interventional Scientific Research Ethics Committee (Decision No: 2025/15-3). The study was conducted in accordance with relevant guidelines and regulations.

Supporting Institution

The authors did not receive support from any organization for the submitted work.

Project Number

None

Thanks

The authors would like to thank all participating nephrologists for their support in this research.

References

• Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: framework and proposal of a new classification and case definition. J Periodontol. 2018;89(Suppl 1):S159-s172. doi:10.1002/jper. 18-0006
• Mehrotra N, Singh S. Periodontitis. StatPearls. StatPearls Publishing. Copyright © 2025, StatPearls Publishing LLC.; 2025.
• Shoji T, Abe T, Matsuo H, et al. Chronic kidney disease, dyslipidemia, and atherosclerosis. J Atheroscler Thromb. 2012;19(4):299-315. doi:10. 5551/jat.10454
• Büberci R, Duranay M. Risk factors for chronic kidney disease progression in patients with solitary kidney. J Health Sci Med. 2022;5(3): 342-347. doi:10.32322/jhsm.1009811
• Luyckx VA, Tuttle KR, Garcia-Garcia G, et al. Reducing major risk factors for chronic kidney disease. Kidney Int Suppl (2011). 2017;7(2):71-87. doi:10.1016/j.kisu.2017.07.003
• Loos BG. Systemic markers of inflammation in periodontitis. J Periodontol. 2005;76(11 Suppl):2106-2115. doi:10.1902/jop.2005.76.11-S. 2106
• Kshirsagar AV, Moss KL, Elter JR, Beck JD, Offenbacher S, Falk RJ. Periodontal disease is associated with renal insufficiency in the Atherosclerosis Risk In Communities (ARIC) study. Am J Kidney Dis. 2005;45(4):650-657. doi:10.1053/j.ajkd.2004.12.009
• Fisher MA, Taylor GW, Shelton BJ, et al. Periodontal disease and other nontraditional risk factors for CKD. Am J Kidney Dis. 2008;51(1):45-52. doi:10.1053/j.ajkd.2007.09.018
• Deschamps-Lenhardt S, Martin-Cabezas R, Hannedouche T, Huck O. Association between periodontitis and chronic kidney disease: systematic review and meta-analysis. Oral Dis. 2019;25(2):385-402. doi: 10.1111/odi.12834
• Schütz JDS, de Azambuja CB, Cunha GR, et al. Association between severe periodontitis and chronic kidney disease severity in predialytic patients: a cross-sectional study. Oral Dis. 2020;26(2):447-456. doi:10. 1111/odi.13236
• Parsegian K, Randall D, Curtis M, Ioannidou E. Association between periodontitis and chronic kidney disease. Periodontol 2000. 2022;89(1): 114-124. doi:10.1111/prd.12431
• Cohen L, Schaeffer M, Davideau JL, Tenenbaum H, Huck O. Obstetric knowledge, attitude, and behavior concerning periodontal diseases and treatment needs in pregnancy: influencing factors in France. J Periodontol. 2015;86(3):398-405. doi:10.1902/jop.2014.140371
• Fisher MA, Taylor GW, West BT, McCarthy ET. Bidirectional relationship between chronic kidney and periodontal disease: a study using structural equation modeling. Kidney Int. 2011;79(3):347-355. doi: 10.1038/ki.2010.384
• Kaymaz K, Brunet-Llobet L, Rocha-Eiroa MD, et al. Patient-related factors that link chronic kidney disease and periodontitis: a scoping review. Odontology. 2025;113(3):865-877. doi:10.1007/s10266-024-01031-y
• Kapellas K, Singh A, Bertotti M, Nascimento GG, Jamieson LM. Periodontal and chronic kidney disease association: a systematic review and meta-analysis. Nephrology (Carlton). 2019;24(2):202-212. doi:10. 1111/nep.13225
• Lertpimonchai A, Rattanasiri S, Tamsailom S, et al. Periodontitis as the risk factor of chronic kidney disease: mediation analysis. J Clin Periodontol. 2019;46(6):631-639. doi:10.1111/jcpe.13114
• Iwasaki M, Taylor GW, Sato M, Minagawa K, Ansai T, Yoshihara A. Effect of chronic kidney disease on progression of clinical attachment loss in older adults: a 4-year cohort study. J Periodontol. 2019;90(8):826-833. doi:10.1002/jper.18-0464
• Bastos Jdo A, Vilela EM, Henrique MN, et al. Assessment of knowledge toward periodontal disease among a sample of nephrologists and nurses who work with chronic kidney disease not yet on dialysis. J Bras Nefrol. 2011;33(4):431-435.
• Wallace CK, Vernazza CR, Emmet V, et al. Evaluation of UK paediatric nephrology teams' understanding, experience and perceptions of oral health outcomes and accessibility to dental care: a mixed-methods study. Pediatr Nephrol. 2024;39(7):2131-2138. doi:10.1007/s00467-024-06292-x
• Umeizudike KA, Iwuala SO, Ozoh OB, Ekekezie OO, Umeizudike TI. Periodontal systemic interaction: perception, attitudes and practices among medical doctors in Nigeria. J West Afr Coll Surg. 2015;5(2):43-65.
• Blue C, Isringhausen K, Dils E. Raising oral health awareness among nephrology nurses. J Dent Hyg. 2011;85(2):151-157.
• Abed H, Burke M, Shaheen F. The integrated care pathway of nephrology and dental teams to manage complex renal and postkidney transplant patients in dentistry: a holistic approach. Saudi J Kidney Dis Transpl. 2018;29(4):766-774. doi:10.4103/1319-2442.239634
• Piekoszewska-Ziętek P, Pańczyk-Tomaszewska M, Olczak-Kowalczyk D. Evaluation of oral hygiene and gingival parameters in pediatric nephrotic syndrome within an interdisciplinary care model. Sci Rep. 2025;15(1):21735. doi:10.1038/s41598-025-06687-2
• Anuradha BR, Katta S, Kode VS, et al. Oral and salivary changes in patients with chronic kidney disease: a clinical and biochemical study. J Indian Soc Periodontol. 2015;19(3):297-301. doi:10.4103/0972-124x. 154178
• Marinoski J, Bokor-Bratic M, Mitic I, Cankovic M. Oral mucosa and salivary findings in non-diabetic patients with chronic kidney disease. Arch Oral Biol. 2019;102:205-211. doi:10.1016/j.archoralbio.2019.04.021
• Honarmand M, Farhad-Mollashahi L, Nakhaee A, Sargolzaie F. Oral manifestation and salivary changes in renal patients undergoing hemodialysis. J Clin Exp Dent. 2017;9(2):e207-e210. doi:10.4317/jced. 53215
• Andrade MR, Antunes LA, Soares RM, Leão AT, Maia LC, Primo LG. Lower dental caries prevalence associated to chronic kidney disease: a systematic review. Pediatr Nephrol. 2014;29(5):771-778. doi:10.1007/s00467-013-2437-4
• Akar H, Akar GC, Carrero JJ, Stenvinkel P, Lindholm B. Systemic consequences of poor oral health in chronic kidney disease patients. Clin J Am Soc Nephrol. 2011;6(1):218-26. doi:10.2215/cjn.05470610
• Gaál Kovalčíková A, Pančíková A, Konečná B, et al. Urea and creatinine levels in saliva of patients with and without periodontitis. Eur J Oral Sci. 2019;127(5):417-424. doi:10.1111/eos.12642
• Wahid A, Chaudhry S, Ehsan A, Butt S, Ali Khan A. Bidirectional relationship between chronic kidney disease & periodontal disease. Pak J Med Sci. 2013;29(1):211-215. doi:10.12669/pjms.291.2926