Chronic Kidney Disease Associated Diet

The Dietary Inflammatory Index (DII) provides a score that measures the potential for a person's diet to cause inflammation in the body. This index is based on the pro- or anti-inflammatory effects of consumed foods and nutrients. Participants' 3-day food intake records will be entered into the system, and average daily energy intake, macronutrients, and micronutrients will be calculated. Based on the food records, average daily intake of 36 nutrients will be determined, and DII scores will be derived from these nutrient parameters. A lower score indicates a more antiinflammatory diet, while a higher score indicates a more proinflammatory diet.

Plaque Index (PI) (Silness and Löe, 1964) This index is used to evaluate the amount of dental plaque accumulation on tooth surfaces. Each tooth's four surfaces (buccal, lingual, mesial, distal) are examined using a probe or visually. Each surface is scored from 0 to 3. The average score is calculated for each tooth. The overall plaque index is obtained by averaging the scores from all examined teeth.

Score Description 0 No plaque.

• No visible plaque, but a slight film of plaque is detected when a probe is run along the gingival margin.
• Visible plaque along the gingival margin, forming a continuous band.
• Abundant plaque covering the gingival area and extending toward the middle of the tooth surface, including the interproximal spaces.

The Gingival Index is used to assess the presence and severity of gingival inflammation (gingivitis). Four surfaces of each tooth (buccal, lingual, mesial, distal) are examined visually and with a periodontal probe. The evaluation considers color changes, edema (swelling), tissue consistency, and bleeding on probing. Each surface is scored from 0 to 3. The average score per tooth is calculated, and then the overall average is used to determine the individual's GI score.

Score Description 0 Healthy gingiva: normal color and texture, no bleeding

• Mild inflammation: slight color change and swelling, no bleeding on probing
• Moderate inflammation: redness, edema, soft tissue, bleeding on probing
• Severe inflammation: marked redness and swelling, ulceration, possible spontaneous bleeding

This index is used to assess the presence and severity of gingival inflammation by observing bleeding after gentle pressure is applied to the gingival sulcus using a periodontal probe. A thin periodontal probe is gently inserted into the gingival sulcus with light pressure (approximately 20-25 grams). Bleeding occurring within 10-30 seconds is observed. Each measurement site is recorded as either "bleeding present" or "bleeding absent." Presence of bleeding is an early and sensitive indicator of gingival inflammation.

Score Description: 0 No bleeding 1 Bleeding present (mild or severe)

Using a Williams periodontal probe, the distance between the gingival margin and the base of the periodontal pocket is measured in millimeters at six sites per tooth: mesiobuccal, midbuccal, distobuccal, mesiolingual, midlingual, and distolingual. All teeth are measured. The values obtained from each site are summed and then divided by the total number of sites measured. This gives the average probing depth for the individual.

Measurement Interpretation 1-3 mm Healthy sulcus 4-5 mm Shallow to moderate pocket

≥6 mm Deep periodontal pocket (advanced disease)

Using a Williams periodontal probe, the distance between the enamel-cementum junction and the base of the periodontal pocket is measured in millimeters at six sites per tooth: mesiobuccal, midbuccal, distobuccal, mesiolingual, midlingual, and distolingual. All teeth are measured. The values obtained from each site are summed and then divided by the total number of sites measured. This gives the average probing depth for the individual.

CAL Value Interpretation 0-1 mm Healthy / minimal loss 2-3 mm Mild attachment loss 4-5 mm Moderate attachment loss

≥6 mm Severe attachment loss

Creatinine is a waste product generated from muscle metabolism and excreted by the kidneys; its serum level is used to assess renal function.

Albumin is the main serum protein synthesized by the liver that maintains plasma oncotic pressure; it provides information about nutritional status and kidney function.

Blood urea nitrogen (BUN) represents the amount of nitrogen in the blood derived from urea, a byproduct of protein metabolism, and is an indicator of renal function.

Glomerular filtration rate (GFR) indicates the volume of blood filtered by the kidneys per minute and is a key parameter for evaluating renal function.

High-sensitivity C-reactive protein (hsCRP) is a sensitive marker used to detect low-grade systemic inflammation.

Vitamin D is a fat-soluble vitamin that regulates calcium-phosphorus metabolism and plays a role in bone health and immune function.

Uric acid is the end product of purine metabolism, and elevated levels are associated with gout and kidney disease.

Ferritin is a protein responsible for iron storage in the body, and its serum level reflects iron stores.

Iron is an essential trace element involved in hemoglobin synthesis and oxygen transport.

Phosphorus is an essential mineral involved in bone mineralization and cellular energy metabolism.

Calcium is a vital mineral required for bone and dental health, muscle contraction, and nerve transmission.

Parathyroid hormone (PTH) is a hormone secreted by the parathyroid glands that regulates calcium and phosphorus balance.

Platelets are anucleate blood cell fragments derived from megakaryocytes in the bone marrow, and their primary function is to participate in blood clot formation (hemostasis) to prevent bleeding.

Lymphocytes are key cells of the adaptive immune system and mainly consist of T cells, B cells, and natural killer (NK) cells; they generate specific immune responses against infections and foreign antigens.

Neutrophils are the most abundant leukocytes in the innate immune system and constitute the first line of defense against bacterial infections by destroying microorganisms through phagocytosis.