Effectiveness of Subgingival Instrumentation on Delaying End-stage Renal Diseases Among Chronic Kidney Disease Patients

Chronic kidney disease (CKD) and periodontitis share a bidirectional inflammatory relationship, with cytokines such as IL-6, TNF-α, and hsCRP driving progression in both conditions. Non-surgical periodontal therapy (NSPT) has shown reductions in systemic inflammatory markers with emerging evidence of improved renal function, yet robust Randomized controlled trials targeting pre-dialysis Stage IV-V diabetic CKD patients remain lacking. In the Indian context, where diabetes-related CKD is rapidly rising and access to dialysis is limited, there is a clear lacuna in literature regarding the effectiveness of NSPT in delaying progression to end-stage renal disease. Hence, the present Randomized controlled trial is undertaken to address this gap.

Inclusion Criteria: * Patients aged 40-70 years. * Type 2 diabetes mellitus with chronic kidney diseases and currently on oral hypoglycemic agents. * Diagnosed with Stage IV or V (eGFR between 15-20 mL/min/1.73m²). * Not undergoing dialysis. * Presence of ≥20 natural teeth. * Diagnosed with moderate (Stage II) (as per 2017 World Workshop classification) (Interdental CAL at site of greatest loss \>2mm but \8 %. * Any Periodontal therapy within past 6 months. * Immunocompromised patients. * Any history of tobacco use. * Pregnant or lactating women.