Increased risk of incident psoriasis in end‐stage renal disease patients on chronic hemodialysis: A nationwide population‐based cohort study

Abstract

Patients with end-stage renal disease (ESRD) on chronic hemodialysis (HD) experience chronic inflammation and immune dysregulation; whether these affect the development of chronic inflammatory disease such as psoriasis is unknown. We aimed to investigate the impact of ESRD on the development of psoriasis. We performed a retrospective cohort study using records between 1999 and 2013 from Taiwan's National Health Insurance Research Database. Among 74 916 patients with ESRD on chronic HD and the control group comprising 74 916 sex and age group-matched patients, 165 and 81 incident psoriasis developed after a mean follow up of 2.4 and 2.9 years, respectively. The incidence rates of psoriasis in HD patients and the control group were 91.7 and 37.1 per 100 000 person-years, respectively (difference between groups, P < 0.001). HD patients had a shorter time to psoriasis diagnosis than the control group (P < 0.05). Cox proportional hazard adjustment showed the hazard ratio (HR) for psoriasis in HD patients as 2.09 (95% confidence interval [CI], 1.49-2.94; P < 0.001) than that of the control group. Younger HD patients had relatively higher risk of psoriatic development (age <60 years; adjusted HR, 3.68; 95% CI, 1.93-7.02; P < 0.001). The relative risk of psoriatic arthritis was not increased in HD patients compared with the control group. In conclusion, patients with ESRD on chronic HD had a greater risk of developing psoriasis. Physicians should be aware of the predisposition to psoriasis in patients with ESRD on chronic HD.

Interleukin-17A and Keratinocytes in Psoriasis

“…Psoriasis is also significantly comorbid with other autoimmune diseases, such as bullous pemphigoid [20][21][22][23][24]. Psoriasis is frequently associated with cardiovascular diseases, metabolic diseases, and renal disorders [25][26][27][28][29][30][31][32][33][34][35][36]. Cancer risk is slightly higher in patients with psoriasis [37].…”

The CCL20 and CCR6 axis in psoriasis

“…Genetic factors also play a crucial role in the development of psoriasis . Psoriasis is also comorbid with cardiovascular diseases, metabolic diseases and renal disorders, which represents a condition known as the inflammatory skin march …”

“…14 Psoriasis is also comorbid with cardiovascular diseases, metabolic diseases and renal disorders, which represents a condition known as the inflammatory skin march. [15][16][17][18][19][20][21][22][23] The infiltrating dermal dendritic cells produce large amounts of TNF-α and IL-23 and induce the differentiation of IL-17A-producing helper T (Th17) cells ( Figure 1). 24,25 IL-17A upregulates the proliferation of keratinocytes and downregulates the differentiation of these cells.…”

Risk of End-Stage Renal Disease in Psoriatic Patients: Real-World Data from a Nationwide Population-Based Cohort Study

“…Wang et al . showed that patients with ESRD on chronic hemodialysis are at increased risk of psoriasis 16 . Moreover, psoriatic patients are at risk of renal disease, the magnitude of which increases with worsening severity of psoriasis 17–19 .…”