Risk of incident chronic kidney disease and end-stage renal disease in patients with psoriasis: A nationwide population-based cohort study. Issue 3 (June 2015)

• Record Type: Journal Article
• Authors: Chi, Ching-Chi; Wang, Jui; Chen, Yu-Fen; Wang, Shu-Hui; Chen, Fu-Li; Tung, Tao-Hsin
• Is Part Of: Journal of dermatological science. Volume 78:Issue 3(2015:Jun.)
• Page Start: 232
• Page End: 238
• Publication Date: 2015-06
• Subjects: Chronic kidney disease -- End-stage renal disease -- Psoriasis -- Psoriatic arthritis; Dermatology -- Periodicals; Skin Diseases -- Periodicals; Dermatologie -- Périodiques; 616.5005
• DOI: 10.1016/j.jdermsci.2015.03.012
• Languages: English
• ISSNs: 0923-1811

Abstract

Highlights: Severe psoriasis is an independent risk factor chronic kidney disease and end-stage renal disease. Psoriatic arthritis is an effect modifier for chronic kidney disease and end-stage renal disease. In patients with severe psoriasis, renal function should be assessed and long-term use of nephrotoxic drugs be avoided. Abstract: Background: Psoriasis is a chronic inflammatory dermatosis that has been associated with various cardiovascular and metabolic comorbidities, including myocardial infarction, stroke, and diabetes mellitus. Recently, there are studies reporting the association of psoriasis with renal diseases. Objective: To evaluate the risk of incident chronic kidney disease (CKD) and end-stage renal disease (ESRD) in people with psoriasis. Methods: We used the Taiwan's National Health Insurance Research Database to conduct a nationwide population-based cohort study to assess the risk of incident CKD and ESRD in people with psoriasis and to further evaluate the respective risk estimates in those with mild and severe psoriasis based on treatment patterns. Results: A total of 4633 psoriatic patients and 922, 534 nonpsoriatic controls were included. Severe psoriasis, but not mild psoriasis, was an independent risk factor of incident CKD and ESRD (adjusted hazard ratio being 1.90 (95% confidence interval 1.33–2.70) and 2.97 (95% confidence interval 1.72–5.11), respectively) after adjustment for potential confounders including age, gender, comorbidities, and used of nonsteroidal anti-inflammatory drugs (NSAIDs). Severe psoriasis remained an independent risk factor of incident CKD and ESRD after various sensitivity analyses after adjusting for the presence of osteoarthritis and/or rheumatoid arthritis, use of methotrexate and/or cyclosporine, and chronic use of NSAIDs for at least 2 months. Psoriatic arthritis was an effect modifier for CKD and ESRD. Conclusions: The associations of severe psoriasis with CKD and ESRD should be recognized. Assessment of renal function and avoidance of long-term use of nephrotoxic drugs shall be implemented in the integrative care for patients with severe psoriasis.