Clear link discovered between chronic kidney disease and periodontal disease

Their article in BMC Nephrology combined evidence from more than 150 previously published papers, including observational studies, meta-analyses and interventional trials, and identified growing evidence of oral-renal interactions.

“We know there is an association between chronic kidney disease (CKD) and oral diseases,” said Priyanka Gudsoorkar, the study’s first author and an assistant professor-educator in the Department of Environmental and Public Health Sciences. “The emerging evidence supports a bidirectional relationship.”

Researchers said the relationship appears to be driven by immune dysregulation, endothelial dysfunction (narrowing of the blood vessels), microbial dysbiosis (oral microbial imbalance) and systemic inflammation. Periodontal disease and CKD have interlinked inflammatory pathways that may contribute to disease progression.

“Systemic inflammation is linked to a triad of other conditions: diabetes mellitus, cardiovascular disease and hypertension encompassing metabolic syndrome,” said Prakash Gudsoorkar, MD, the study’s corresponding author and an associate professor in the Division of Nephrology in the Department of Internal Medicine. He added that patients with kidney disease at all stages face increased risk for these conditions.

“This triad operates as a clinical cascade,” said Prakash Gudsoorkar, who is also a UC Health nephrologist. Diabetes and hypertension accelerate the decline of kidney function, while cardiovascular disease becomes a dominant risk factor. CKD also multiplies the risk of complications involving glycemic control, medication management and complex care needs.

“We see oral disease severity increase as CKD progresses, and the literature supports a biologically plausible relationship,” said Priyanka Gudsoorkar. “What we still need are well-designed prospective studies and clinical trials to clarify the direction and magnitude of causality.”

However, the study found many physicians still treat oral health separately from chronic disease, rather than integrating it into a broader treatment strategy that could allow for earlier identification and better risk assessment.

This disconnect can be especially significant for patients undergoing dialysis and awaiting kidney transplants. Pretransplant dental clearance is typically required before surgery. For some patients, kidney transplant waits can stretch for years, and untreated oral infections can delay the procedure and become a preventable barrier to transplant readiness.

“Oral infection and untreated periodontal disease can complicate continuity of care,” said Priyanka Gudsoorkar, who is also director of the global health concentration within UC’s Bachelor of Science in Public Health program. 

“For many patients, transplant evaluation is the first point in their kidney care journey when a dental referral becomes a standard requirement,” she said. “So closer monitoring of oral health in patients on dialysis is needed, along with better management of periodontal inflammation.”

Researchers are now calling on physicians to begin integrating oral and renal health more directly within clinical care systems. “We need to build a framework that supports oral and renal care integration across the CKD continuum,” said Prakash Gudsoorkar.

An improved framework, which could include implementing standardized care protocols and improved sharing of patient health records across specialties, could also enable earlier intervention and ease economic burden for patients, he explained.

As evidence of a link between CKD and oral diseases grows, the topic has gained attention among leading clinicians and researchers. 

"Mouth and Kidneys: Unveiling the Crosstalk Between Oral and Kidney Health," written by Priyanka Gudsoorkar, Prakash Gudsoorkar and Sujay Mehta and published in the American Society of Nephrology’s Kidney News, was selected by the publication’s editor-in-chief as one of its top five articles of 2025. 

Highlighting the need for policy reform, Priyanka Gudsoorkar and Prakash Gudsoorkar also published a perspective in late 2025 in the International Dental Journal: “Integrating Oral Health Into Kidney Care: A Policy Imperative for Chronic Kidney Disease, the U.S. Experience.”

The authors and other experts in clinical dentistry and nephrology have formed the Oral-Kidney Collaborative for Advancing Research and Evidence (OK-CARE), a multidisciplinary initiative to advance research, clinical collaboration and policy development at the intersection of oral health and kidney disease. 

Collaborators outside UC include: C. Elena Cervantes of Johns Hopkins School of Medicine; Isabella Lerma of Marquette University; Anay Dudhbhate of George Brown Polytechnic in Toronto, Canada; Sujay Mehta and Ramprasad Vasthare of Manipal College of Dental Sciences in Udupi, India; Edgar Lerma of the University of Illinois at Chicago; Lakshman Samaranayake and Chun Wang Chau of the University of Hong Kong; Sabine Karam of the University of Minnesota; Sompop Bencharit and Abhjit Kshirsagar of the University of North Carolina at Chapel Hill; and Ryan S. Lee, a dental subject matter expert.

Featured image at top: Priyanka and Prakash Gudsoorkar in the CARE/Crawley building on the medical campus. Photo/Connor Boyle/UC Marketing + Brand.