Chronic kidney disease and chronic oral inflammatory diseases: A systematic review and meta-analysis of periodontitis and apical periodontitis

Abstract

Background: Chronic kidney disease (CKD) has been increasingly associated with oral chronic inflammatory conditions, including periodontitis (PD) and apical periodontitis (AP). Both share common pathophysiological pathways involving systemic inflammation, immune dysregulation, and oxidative stress. This systematic review and meta-analysis aimed to synthesize current evidence on the association between CKD and chronic oral inflammatory diseases. Methods: The PRISMA guidelines were followed and the proto-col was registered in PROSPERO: CRD420251167323. A comprehensive electronic search was conducted in PubMed, Scopus, Web of Science, and ProQuest up to September 2025. Observational studies reporting prevalence of chronic oral inflammatory diseases in CKD patients and controls subjects were included. The Newcastle-Ottawa scale was used for assessing risk of bias. Pooled odds ratios (ORs) were calculated using a random-effects model. Results: Seven studies published between 2011 and 2025, including 13,139 participants, met the inclusion criteria. CKD patients had significantly higher prevalence of oral inflammatory disease than controls (OR = 4.2; 95% CI = 2.5-7.2; p < 0.00001). Heterogeneity was high (I2 = 83.0%). Subgroup analysis showed an OR of 4.3 (95% CI = 2.6-7.0; p < 0.0001) for AP and 4.3 (95% CI = 2.2-8.7) for PD. The overall risk of bias was moderate, and the certainty of evidence according to GRADE was rated as low. Conclusions This systematic review and meta-analysis highlight a potential link between chronic oral inflammatory disease, including both AP and PD, and chronic kidney disease (CKD). However, the certainty of the evidence is low, and substantial heterogeneity exists across studies.