Severe Psoriasis Risk Kidney Disease

PHILADELPHIA — The latest look at connections between psoriasis and other serious medical conditions revealed for the first time that people with more serious cases of psoriasis are at twice the risk of developing  chronic kidney disease and four times the risk of developing end stage renal disease requiring dialysis. Researchers from the Perelman School of Medicine at the University of Pennsylvania published a study in the British Medical Journal showing that patients with mild forms of the disease are not at an increased risk, but those with psoriasis on more than 3 percent of their body are at greater risk. Psoriasis increases this risk independently, regardless of other risk factors for kidney disease, such as diabetes, hypertension or use of NSAIDS.

“With this knowledge, physicians can change how they practice: they can proactively screen moderate to severe psoriasis patients for kidney disease with simple blood and urine tests and  carefully consider prescribing any medications that could be toxic to the kidneys,” said senior study author, Joel M. Gelfand, MD, MSCE, associate professor of Dermatology and Epidemiology.

The research team analyzed a database including 136,529 patients with mild psoriasis and 7,354 patients with severe psoriasis and matched them to 689,702 unaffected patients.  Also, in a nested-analysis of data from the incident health outcomes and psoriasis events (iHOPE) study, they evaluated the prevalence of chronic kidney disease in 9,000 psoriasis patients being followed prospectively through the electronic medical record in whom their general practitioners provided additional information about psoriasis such as body surface area affected to Dr. Gelfand and his team.  They found associations with moderate to advanced kidney disease in patients with both moderate and severe psoriasis, which are estimated to affect over 20 percent of psoriasis patients worldwide.

The relative risk appeared to be highest among younger patients with severe psoriasis. The team looked and found that the association between severe psoriasis and renal insufficiency was not driven by joint disease or its associated use of nephrotoxic drugs.

“While the mechanisms related to renal injury in psoriasis remain unclear, this study is the first large scale, well controlled investigation evaluating kidney disease and psoriasis,” said Gelfand. “These findings will likely change clinical practice recommendations.”