• Eke, P. I., Dye, B. A., Wei, L., Thornton-Evans, G. O. & Genco, R. J. & Cdc Periodontal Disease Surveillance workgroup: James Beck, G. D. R. P. Prevalence of periodontitis in adults in the United States: 2009 and 2010. J. Dent. Res. 91, 914–920 (2012).

    Article 
    CAS 
    PubMed 

    Google Scholar
     

  • Nazir, M. A. Prevalence of periodontal disease, its association with systemic diseases and prevention. Int J. Health Sci. 11, 72–80 (2017).


    Google Scholar
     

  • Chen, M. X., Zhong, Y. J., Dong, Q. Q., Wong, H. M. & Wen, Y. F. Global, regional, and national burden of severe periodontitis, 1990-2019: An analysis of the Global Burden of Disease Study 2019. J. Clin. Periodontol. 48, 1165–1188 (2021).

    Article 
    PubMed 

    Google Scholar
     

  • Buhlin, K., Gustafsson, A., Pockley, A. G., Frostegard, J. & Klinge, B. Risk factors for cardiovascular disease in patients with periodontitis. Eur. Heart J. 24, 2099–2107 (2003).

    Article 
    PubMed 

    Google Scholar
     

  • Sanz, M. et al. Periodontitis and Cardiovascular Diseases. Consensus Report. Glob. Heart 15, 1 (2020).

    Article 
    CAS 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Chambrone, L. et al. Periodontitis and chronic kidney disease: a systematic review of the association of diseases and the effect of periodontal treatment on estimated glomerular filtration rate. J. Clin. Periodontol. 40, 443–456 (2013).

    Article 
    CAS 
    PubMed 

    Google Scholar
     

  • Parsegian, K., Randall, D., Curtis, M. & Ioannidou, E. Association between periodontitis and chronic kidney disease. Periodontol 2000 89, 114–124 (2022).

    Article 
    PubMed 

    Google Scholar
     

  • Francis, A. et al. Chronic kidney disease and the global public health agenda: an international consensus. Nat. Rev. Nephrol. 20, 473–485 (2024).

    Article 
    PubMed 

    Google Scholar
     

  • Tangri, N. et al. Prevalence of undiagnosed stage 3 chronic kidney disease in France, Germany, Italy, Japan and the USA: results from the multinational observational REVEAL-CKD study. BMJ Open 13, e067386 (2023).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Bikbov, B., Purcell, C. A., Levey, A. S., Smith, M. & Abdoli, A. GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 395, 709-733 (2020).

  • Webster, A. C., Nagler, E. V., Morton, R. L. & Masson, P. Chronic kidney disease. Lancet 389, 1238–1252 (2017).

    Article 
    PubMed 

    Google Scholar
     

  • Fisher, M. A. et al. Periodontal disease and other nontraditional risk factors for CKD. Am. J. Kidney Dis. 51, 45–52 (2008).

    Article 
    PubMed 

    Google Scholar
     

  • Kotecha, K. et al. High prevalence of periodontal disease observed in patients on hemodialysis: a call for equitable access to dental care. Kidney Int Rep. 7, 2097–2100 (2022).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Dannewitz, B. et al. Status of periodontal health in German patients suffering from chronic kidney disease-Data from the GCKD study. J. Clin. Periodontol. 47, 19–29 (2020).

    Article 
    PubMed 

    Google Scholar
     

  • Schutz, J. D. S. et al. Association between severe periodontitis and chronic kidney disease severity in predialytic patients: A cross-sectional study. Oral. Dis. 26, 447–456 (2020).

    Article 
    PubMed 

    Google Scholar
     

  • He, I. et al. Demystifying the connection between periodontal disease and chronic kidney disease – An umbrella review. J. Periodontal Res. 58, 874–892 (2023).

    Article 
    CAS 
    PubMed 

    Google Scholar
     

  • Deschamps-Lenhardt, S., Martin-Cabezas, R., Hannedouche, T. & Huck, O. Association between periodontitis and chronic kidney disease: Systematic review and meta-analysis. Oral. Dis. 25, 385–402 (2019).

    Article 
    CAS 
    PubMed 

    Google Scholar
     

  • Kapellas, K., Singh, A., Bertotti, M., Nascimento, G. G. & Jamieson, L. M. Periodontal and chronic kidney disease association: A systematic review and meta-analysis. Nephrology 24, 202–212 (2019).

    Article 
    PubMed 

    Google Scholar
     

  • Clark, D., Radaic, A. & Kapila, Y. Cellular Mechanisms of Inflammaging and Periodontal Disease. Front. Dent. Med. https://doi.org/10.3389/fdmed.2022.844865 (2022).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Clark, D., Kotronia, E. & Ramsay, S. E. Frailty, aging, and periodontal disease: Basic biologic considerations. Periodontol. 2000 87, 143–156 (2021).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Li, S. et al. Periodontal disease and chronic kidney disease: mechanistic insights and novel therapeutic perspectives. Front. Cell Infect. Microbiol 15, 1611097 (2025).

    Article 
    CAS 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Sharma, P. et al. Oxidative stress links periodontal inflammation and renal function. J. Clin. Periodontol. 48, 357–367 (2021).

    Article 
    CAS 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Chapple, I. L. C., Hirschfeld, J., Cockwell, P., Dietrich, T. & Sharma, P. Interplay between periodontitis and chronic kidney disease. Nat. Rev. Nephrol. 21, 226–240 (2025).

    Article 
    PubMed 

    Google Scholar
     

  • D’Aiuto, F. et al. Systemic effects of periodontitis treatment in patients with type 2 diabetes: a 12 month, single-centre, investigator-masked, randomised trial. Lancet Diab. Endocrinol. 6, 954–965 (2018).

    Article 

    Google Scholar
     

  • Hajishengallis, G. & Chavakis, T. Local and systemic mechanisms linking periodontal disease and inflammatory comorbidities. Nat. Rev. Immunol. 21, 426–440 (2021).

    Article 
    CAS 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Hajishengallis, G. Periodontitis: from microbial immune subversion to systemic inflammation. Nat. Rev. Immunol. 15, 30–44 (2015).

    Article 
    CAS 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • El-Shinnawi, U. & Soory, M. Associations between periodontitis and systemic inflammatory diseases: response to treatment. Recent Pat. Endocr. Metab. Immune Drug Discov. 7, 169–188 (2013).

    Article 
    CAS 
    PubMed 

    Google Scholar
     

  • Li, L. et al. Periodontitis exacerbates and promotes the progression of chronic kidney disease through oral flora, cytokines, and oxidative stress. Front Microbiol 12, 656372 (2021).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Araújo, M. V. et al. End stage renal disease as a modifier of the periodontal microbiome. BMC Nephrol. 16, 80 (2015).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • de Oliveira, C., Watt, R. & Hamer, M. Toothbrushing, inflammation, and risk of cardiovascular disease: results from Scottish Health Survey. BMJ 340, c2451 (2010).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Lira-Junior, R., Figueredo, C. M., Bouskela, E. & Fischer, R. G. Severe chronic periodontitis is associated with endothelial and microvascular dysfunctions: a pilot study. J. Periodontol. 85, 1648–1657 (2014).

    Article 
    PubMed 

    Google Scholar
     

  • Dorn, B. R., Dunn, W. A. Jr. & Progulske-Fox, A. Invasion of human coronary artery cells by periodontal pathogens. Infect. Immun. 67, 5792–5798 (1999).

    Article 
    CAS 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Bui, F. Q. et al. Association between periodontal pathogens and systemic disease. Biomed. J. 42, 27–35 (2019).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Cullin, N., Azevedo Antunes, C., Straussman, R., Stein-Thoeringer, C. K. & Elinav, E. Microbiome and cancer. Cancer Cell 39, 1317–1341 (2021).

    Article 
    CAS 
    PubMed 

    Google Scholar
     

  • Chopra, A. et al. Exploring the presence of oral bacteria in non-oral sites of patients with cardiovascular diseases using whole metagenomic data. Sci. Rep. 14, 1476 (2024).

    Article 
    CAS 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Ishigami, J. et al. CKD and Risk for Hospitalization With Infection: The Atherosclerosis Risk in Communities (ARIC) Study. Am. J. Kidney Dis. 69, 752–761 (2017).

    Article 
    PubMed 

    Google Scholar
     

  • Baciu, S. F., Mesaros, A. S. & Kacso, I. M. Chronic kidney disease and periodontitis interplay-a narrative review. Int J. Environ. Res. Public Health. https://doi.org/10.3390/ijerph20021298 (2023).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Hu, J. et al. Location-specific oral microbiome possesses features associated with CKD. Kidney Int Rep. 3, 193–204 (2018).

    Article 
    PubMed 

    Google Scholar
     

  • Guo, S. et al. Characteristics of human oral microbiome and its non-invasive diagnostic value in chronic kidney disease. Biosci. Rep. https://doi.org/10.1042/bsr20210694 (2022).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Gan, Y. et al. Difference in oral microbiota composition between patients with stage 5 chronic kidney disease on hemodialysis and healthy controls. Am. J. Transl. Res. 15, 3342–3354 (2023).

    CAS 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Wangerin, C. et al. Long-term association of periodontitis with decreased kidney function. Am. J. Kidney Dis. 73, 513–524 (2019).

    Article 
    PubMed 

    Google Scholar
     

  • Ioannidou, E., Swede, H. & Dongari-Bagtzoglou, A. Periodontitis predicts elevated C-reactive protein levels in chronic kidney disease. J. Dent. Res. 90, 1411–1415 (2011).

    Article 
    CAS 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Niedzielska, I. et al. The odontogenic-related microinflammation in patients with chronic kidney disease. Ren. Fail 36, 883–888 (2014).

    Article 
    PubMed 

    Google Scholar
     

  • Beernink, J. M., van Mil, D., Laverman, G. D., Heerspink, H. J. L. & Gansevoort, R. T. Developments in albuminuria testing: A key biomarker for detection, prognosis and surveillance of kidney and cardiovascular disease-A practical update for clinicians. Diab Obes. Metab. https://doi.org/10.1111/dom.16359 (2025).

    Article 

    Google Scholar
     

  • Singh, D., Whooley, M. A., Ix, J. H., Ali, S. & Shlipak, M. G. Association of cystatin C and estimated GFR with inflammatory biomarkers: the Heart and Soul Study. Nephrol. Dial. Transpl. 22, 1087–1092 (2007).

    Article 
    CAS 

    Google Scholar
     

  • Papapanou, P. N. et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J. Clin. Periodontol. 45, S162–s170 (2018).

    Article 
    PubMed 

    Google Scholar
     

  • Caton, J. G. et al. A new classification scheme for periodontal and peri-implant diseases and conditions – Introduction and key changes from the 1999 classification. J. Clin. Periodontol. 45, S1–s8 (2018).

    Article 
    PubMed 

    Google Scholar
     

  • Astley, M. E. et al. Age- and sex-specific reference values of estimated glomerular filtration rate for European adults. Kidney Int. 107, 1076–1087 (2025).

    Article 
    PubMed 

    Google Scholar
     

  • Kshirsagar, A. V. et al. Periodontal disease is associated with renal insufficiency in the Atherosclerosis Risk In Communities (ARIC) study. Am. J. Kidney Dis. 45, 650–657 (2005).

    Article 
    PubMed 

    Google Scholar
     

  • Sanz, M. et al. Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline. J. Clin. Periodontol. 47(Suppl 22), 4–60 (2020).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Petreski, T., Piko, N., Ekart, R., Hojs, R. & Bevc, S. Review on inflammation markers in chronic kidney disease. Biomedicines. https://doi.org/10.3390/biomedicines9020182 (2021).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Martínez-García, M. & Hernández-Lemus, E. Periodontal inflammation and systemic diseases: an overview. Front Physiol. 12, 709438 (2021).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Tonelli, M., Sacks, F., Pfeffer, M., Jhangri, G. S. & Curhan, G. Biomarkers of inflammation and progression of chronic kidney disease. Kidney Int 68, 237–245 (2005).

    Article 
    CAS 
    PubMed 

    Google Scholar
     

  • Amdur, R. L. et al. Inflammation and progression of CKD: The CRIC Study. Clin. J. Am. Soc. Nephrol. 11, 1546–1556 (2016).

    Article 
    CAS 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Koshino, A. et al. Interleukin-6 and cardiovascular and kidney outcomes in patients with Type 2 diabetes: new insights from CANVAS. Diab Care 45, 2644–2652 (2022).

    Article 
    CAS 

    Google Scholar
     

  • Delbove, T. et al. Effect of periodontal treatment on the glomerular filtration rate, reduction of inflammatory markers and mortality in patients with chronic kidney disease: A systematic review. PLoS One 16, e0245619 (2021).

    Article 
    CAS 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Almeida, S., Figueredo, C. M., Lemos, C., Bregman, R. & Fischer, R. G. Periodontal treatment in patients with chronic kidney disease: a pilot study. J. Periodontal Res. 52, 262–267 (2017).

    Article 
    CAS 
    PubMed 

    Google Scholar
     

  • Chaudhry, A. et al. Potential effects of non-surgical periodontal therapy on periodontal parameters, inflammatory markers, and kidney function indicators in chronic kidney disease patients with chronic periodontitis. Biomedicines. https://doi.org/10.3390/biomedicines10112752 (2022).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • França, L. F. C. et al. Periodontitis changes renal structures by oxidative stress and lipid peroxidation. J. Clin. Periodontol. 44, 568–576 (2017).

    Article 
    PubMed 

    Google Scholar
     

  • Randall, D. et al. Oral dysbiosis initiates periodontal disease in experimental kidney disease. Nephrol. Dial. Transpl. 40, 1187–1202 (2025).

    Article 
    CAS 

    Google Scholar
     

  • Okura, T. et al. Association between cystatin C and inflammation in patients with essential hypertension. Clin. Exp. Nephrol. 14, 584–588 (2010).

    Article 
    CAS 
    PubMed 

    Google Scholar
     

  • Benzing, T. & Salant, D. Insights into glomerular filtration and albuminuria. N. Engl. J. Med. 384, 1437–1446 (2021).

    Article 
    CAS 
    PubMed 

    Google Scholar
     

  • Eke, P. I. et al. Periodontitis in US Adults: National Health and Nutrition Examination Survey 2009-2014. J. Am. Dent. Assoc. 149, 576–588.e576 (2018).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Jagodzinski, A. et al. Rationale and Design of the Hamburg City Health Study. Eur. J. Epidemiol. 35, 169–181 (2020).

    Article 
    PubMed 

    Google Scholar
     

  • Organisation for Economic Co-operation and Development: Classifying educational programmes: manual for ISCED-97 implementation in OECD countries; 1999 edition. (1999).

  • Boeing, H., Wahrendorf, J. & Becker, N. EPIC-Germany—A source for studies into diet and risk of chronic diseases. Eur. Investig. Cancer Nutr. Ann. Nutr. Metab. 43, 195–204 (1999).

    Article 
    CAS 

    Google Scholar
     

  • Petersen, E. L. et al. Multi-organ assessment in mainly non-hospitalized individuals after SARS-CoV-2 infection: The Hamburg City Health Study COVID programme. Eur. Heart J. 43, 1124–1137 (2022).

    Article 
    CAS 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Schmidt-Lauber, C. et al. Kidney outcome after mild to moderate COVID-19. Nephrol. Dial. Transpl. 38, 2031–2040 (2023).

    Article 

    Google Scholar
     

  • Walther, C. et al. Association between periodontitis and depression severity – A cross-sectional study of the older population in Hamburg. Brain Behav. Immun. Health 34, 100689 (2023).

    Article 
    CAS 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Schmidt-Lauber, C. et al. Prevalence and characteristics of chronic kidney disease in the Hamburg City Health Study. Nephrol. Dial. Transpl. 40, 1632–1634 (2025).

    Article 

    Google Scholar
     

  • Levey, A. S. et al. A new equation to estimate glomerular filtration rate. Ann. Intern. Med. 150, 604–612 (2009).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Stevens, P. E. & Levin, A. & Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group, M. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann. Intern Med. 158, 825–830 (2013).

    Article 
    PubMed 

    Google Scholar
     

  • Fox, C. S. et al. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis. Lancet 380, 1662–1673 (2012).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar
     

  • Arnlov, J. et al. Low-grade albuminuria and incidence of cardiovascular disease events in nonhypertensive and nondiabetic individuals: the Framingham Heart Study. Circulation 112, 969–975 (2005).

    Article 
    PubMed 

    Google Scholar
     

  • Holtfreter, B. et al. ACES: A new framework for the application of the 2018 periodontal status classification scheme to epidemiological survey data. J. Clin. Periodontol. 51, 512–521 (2024).

    Article 
    PubMed 

    Google Scholar
     

  • Kinane, D. F., Stathopoulou, P. G. & Papapanou, P. N. Periodontal diseases. Nat. Rev. Dis. Prim. 3, 17038 (2017).

    Article 
    PubMed 

    Google Scholar
     

  • CKD Work Group, K. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 105, S117-S314 (2024).

  • Genco, R. J. & Borgnakke, W. S. Risk factors for periodontal disease. Periodontol. 2000 62, 59–94 (2013).

    Article 
    PubMed 

    Google Scholar
     

  • Tingley, D., Yamamoto, T., Hirose, K., Keele, L. & Imai, K. mediation: R Package for Causal Mediation Analysis. J. Stat. Softw. 59, 1–38 (2014).

    Article 

    Google Scholar