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Patients with psoriasis and psoriatic arthritis are at significantly increased risk for end-stage renal disease (ESRD), according to cohort study data published in Scientific Reports.
Investigators conducted a nationwide population-based cohort study using data abstracted from the National Health Insurance Service database of South Korea. The psoriasis cohort comprised all patients diagnosed with psoriasis or psoriatic arthritis between January 2010 and December 2013 identified using International Classification of Diseases (ICD)-10 codes. Patients with psoriasis (n=530,307) were then age- and sex-matched (1:3) with healthy control patients (n=1,590,921) who had database claims during the same period.
All cohort members were followed-up through 2015. The primary end point was newly diagnosed ESRD, defined as the presence of at least 1 claim per year under an ICD-10 code for ESRD. ESRD incidence was calculated as the number of incident cases during follow-up (per 1,000 person-years); the log-rank test was used to assess differences in ESRD incidence between patients with psoriasis and control patients. Patients with psoriasis were further divided into 2 subgroups for analysis: patients receiving systemic treatments and patients receiving non-systemic treatments. Multivariate Cox proportional hazard models were used to assess the between-subgroup differences in ESRD incidence.
Demographic characteristics were similar in patient and control patient groups; the overall mean age was 42.84±20.21 years and 51.39% were men. Baseline prevalence rates of diabetes, hypertension, and dyslipidemia were significantly elevated in the psoriasis group (P <.01). Median follow-up was 3.9 years in the total cohort. Compared with control patients, the psoriasis group had a significantly increased risk for developing ESRD in the unadjusted model (hazard ratio [HR], 1.81; 95% CI, 1.69-1.93; P <.001). This association remained significant after adjustments for age; sex; household income; region; and comorbid diabetes, hypertension, and dyslipidemia (HR, 1.58; 95% CI, 1.47-1.68; P <.001). The incidence of ESRD was 0.69 and 0.38 per 1000 person-years in the psoriasis and control patient cohorts, respectively (log-rank P <.001). In adjusted models, patients in the non-systemically treated group had a significantly elevated risk for ESRD (HR, 1.60; 95% CI, 1.50-1.71; P <.001) compared with controls. The same trend was not observed in patients who received systemic treatments, including acitretin (HR, 0.576; 95% CI, 0.385-0.863), methotrexate (HR, 0.735; 95% CI, 0.329-1.638), and cyclosporin (HR, 0.717; 95% CI, 0.47-1.092). Compared with control patients, patients with psoriatic arthritis had a nearly 8-fold greater risk for incident ESRD (HR, 7.60; 95% CI, 1.90-30.41; P <.001).
As a study limitation, investigators noted that the use of a health insurance database limited assessment of confounders; smoking status, drinking status, body mass index, and physical activity level could not be ascertained. In addition, data on psoriasis severity were not available.
“These findings provide insight into the relationship between psoriasis and the risk of ESRD,” investigators wrote. “The risk of ESRD was increased in patients with psoriasis or psoriatic arthritis but not in those who received systemic treatment for psoriasis.”
Reference
Lee E, Han JH, Bang CH, et al. Risk of end-stage renal disease in psoriatic patients: real-world data from a nationwide population-based cohort study. Sci Rep. 2019;9(1):16581.
