TLR4 rs2149356 Polymorphism in Periodontitis and End-Stage Renal Disease: An Exploratory Analysis in Egyptian Patients

This study explored the association of the TLR4 rs2149356 polymorphism with periodontal and renal parameters in Egyptian end-stage renal disease (ESRD) patients. Ninety-two patients with periodontitis were recruited, forty-six on hemodialysis, and forty-six systemically healthy controls. Clinical periodontal indices, renal biomarkers, and gGenotyping for TLR4 rs2149356 were assessed. Gingival inflammation was significantly higher in ESRD patients across all genotypes. Although the TT genotype showed a trend toward deeper probing depths and greater attachment loss in ESRD patients, these differences did not reach statistical significance after correction. Regression models indicated that TT carriers exhibited higher inflammatory and renal burden, suggesting a potential gene–environment interaction. TLR4 rs2149356 polymorphism may modulate inflammatory response in ESRD and periodontitis patients, although findings remain exploratory. These results highlight the potential role of host–microbe–gene interactions in systemic inflammation, warranting longitudinal and functional studies in larger, multi-ethnic cohorts.