Lertpimonchai A, et al. - Researchers applied mediation analysis with 1,000-replication bootstrapping to two causal diagrams, diagram A [Periodontitis → Diabetes → chronic kidney disease (CKD)] and diagram B (Diabetes → Periodontitis → CKD) in order to determine sequences and magnitude of causality among periodontitis, diabetes and CKD. From the Electric Generation Authority of Thailand (EGAT) study, ten-year-data yielded a cohort of 2,635 subjects with no CKD at baseline. During 10-year period, the cumulative incidence of CKD of 10.3 cases per 100 persons was noted. Outcomes revealed significant direct effect, and indirect effect of periodontitis through diabetes, on the incidence of CKD. In diagram A, for each increase of 1% in proximal sites with severe periodontitis, the adjusted odds ratio of CKD were directly increased by 1.010 and 1.007, by direct and indirect effect through diabetes, respectively. In diagram B, diabetes was identified increasing the odds ratio of CKD occurrence twofold, with 6.5% mediated via periodontitis. These findings emphasize the significance of awareness concerning systemic morbidities from periodontitis.