Periodontal disease is associated with diabetes, heart disease, and chronic kidney disease (CKD), an effect postulated to be due in part to endovascular inflammation. While a bidirectional relationship between CKD and periodontal disease is plausible, it has not been previously reported in the literature. Over 11 200 adults 18 years or older were identified in the Third National Health and Nutrition Examination Survey. Analyses were conducted in two stages. First, multivariable logistic regression models were fitted to test the hypothesis that periodontal disease was independently associated with CKD. Given the potential that the periodontal disease and CKD relationship may be bidirectional, a two-step analytic approach was used that involved 1) tests for mediation, and 2) structural equation models to examine more complex direct and indirect effects of periodontal disease on CKD, and vice versa. In two separate models periodontal disease (OR_Adj =1.62 (95% CI: 1.17-2.26) and edentulism (OR_Adj = 1.83 (1.31-2.55) and periodontal disease score (OR_Adj = 1.01 (1.01-1.02) were associated with CKD, when simultaneously adjusting for 14 other factors. Three of four structural equation models were most plausible suggesting bidirectional relationships. Collectively, these analyses provide for the first time empirical support for a bidirectional relationship between CKD and periodontal disease, and mediation of that relationship by diabetes duration and hypertension.