Diabetes, hypertension, and chronic kidney disease (CKD) commonly co-occur within individuals. A team of University of Michigan and external researchers including CSCAR consultant Brady West recently demonstrated that periodontal disease may also play an important role in this comorbid system (Fisher et al., Kidney International 78, Feb 2011). Using Structural Equation Modeling (SEM), the team found evidence that periodontal disease may increase an individual’s risk for CKD, even when taking into account the roles of diabetes and hypertension. SEM is a powerful technique for establishing the plausibility of causal pathways. It allows competing explanations for a relationship among several variables to be objectively contrasted. This work establishes a strong basis for future longitudinal studies exploring causal pathways in CKD.