Bridging systems: oral-kidney connections - pathophysiological links, clinical implications, and health system integration – a narrative review

Emerging evidence supports a bidirectional relationship between chronic kidney disease (CKD) and oral diseases, mediated by systemic inflammation, endothelial dysfunction, and immune dysregulation. Periodontitis and caries are prevalent yet underrecognized contributors to the inflammatory burden in CKD, particularly in low-resource settings where oral and kidney care remain fragmented. This reviewsynthesizes clinical, epidemiologic, and mechanistic evidence fromobservational studies, interventional trials, and meta-analyses examiningoral–renal interactions. PubMed-indexed literature was analyzed to map oralhealth indices, stage-specific manifestations, and the impact of periodontaltherapy on systemic biomarkers in CKD. Across multipleclinical studies, oral disease severity increases in parallel with CKDprogression and systemic inflammation. Elevated dental indices, includingdecayed, missing, and filled teeth (DMFT), plaque index, gingival index, andclinical attachment loss, correlate with reduced glomerular filtration rate andincreased inflammatory markers such as C-reactive protein and interleukin-6. Non-surgical periodontal therapy modestly improves inflammatory profiles,though renal outcomes remain variable. Post-transplant populations exhibitunique oral complications, including gingival overgrowth, candidiasis, andmucosal neoplasia, linked to immunosuppressive regimens. Oral healthconstitutes a measurable and modifiable determinant in CKD progression.Integrating oral assessments into nephrology care can enhance the monitoring ofsystemic inflammation and improve patient quality of life. Structuralinequities and limited workforce capacity continue to impede global oral–renalintegration. Evidence-based, interdisciplinary strategies are proposed to embedoral health within CKD management pathways.