Lertpimonchai A, et al. - Investigators analyzed 10-year data extracted from the EGAT study to review the sequences and magnitude of causality between periodontitis, diabetes, and chronic kidney disease (CKD) via mediation analysis. At baseline, they identified a cohort of 2,635 subjects with no CKD. They applied mediation analysis with 1,000-replication bootstrapping to two causal diagrams: Diagram A (Periodontitis → Diabetes → CKD), and Diagram B (Diabetes → Periodontitis → CKD). During the 10-year period, the cumulative incidence of CKD was 10.3 cases per 100 persons. They noted that each increasing percentage of proximal sites with severe periodontitis increased the adjusted odds ratio of CKD 1.010 and 1.007, by direct and indirect effect through diabetes, respectively, in diagram A. They also found that diabetes increased the odds of CKD by twofold, with 6.5% of this effect mediated via periodontitis in diagram B. They observed a significant direct effect of periodontitis and an indirect effect through diabetes on the incidence of CKD.