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      Chronic Kidney Disease in Patients with Psoriasis –A Hospital Based Cross Sectional Study

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          Abstract

          Background:

          Psoriasis is a multi-system inflammatory disease where skin and joints are the primary targets. Recently, some studies had shown the association of psoriasis with kidney disease.

          Aims:

          To study the association of psoriasis with chronic kidney disease (CKD) in a tertiary health care center.

          Methodology:

          The study was conducted in the Department of Dermatology in a tertiary care center in Kerala. The study was a descriptive cross-sectional study for 6 months from August 2017 to January 2018. A total of 104 patients with psoriasis were studied. Clinical data was collected. Glomerular filtration rate (GFR) and albumin creatinine ratio (ACR) were found out to know the presence of CKD. Descriptive and inferential statistical analysis has been carried out in the present study.

          Observations:

          Of the 104 patients, 14 were diagnosed as having CKD. Of the 14 CKD patients, 12 had severe psoriasis, 2 had moderate psoriasis, and none had mild psoriasis. The risk factors for CKD (presence of diabetes mellitus/hypertension or intake of drugs—non-steroidal anti-inflammatory drugs [NSAIDs]/cyclosporine) were present in 9 out of 14 CKD patients. The duration of psoriasis was more than 10 years in 10 CKD patients.

          Conclusion:

          Our study demonstrated that psoriatic patients have an increased risk of developing CKD and this risk is found to increase with the severity and duration of psoriasis. Our results require confirmation in large-patient populations in prospective studies or case-control studies.

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          Risk of myocardial infarction in patients with psoriasis.

          Andrea L Neimann, Andrea B Troxel, XingMei Wang … (2006)
          Psoriasis is the most common T-helper cell type 1 (T(H)1) immunological disease. Evidence has linked T(H)1 diseases to myocardial infarction (MI). Psoriasis has been associated with cardiovascular diseases, but has only been investigated in hospital-based studies that did not control for major cardiovascular risk factors. To determine if within a population-based cohort psoriasis is an independent risk factor for MI when controlling for major cardiovascular risk factors. A prospective, population-based cohort study in the United Kingdom of patients with psoriasis aged 20 to 90 years, comparing outcomes among patients with and without a diagnosis of psoriasis. Data were collected by general practitioners as part of the patient's medical record and stored in the General Practice Research Database between 1987 and 2002, with a mean follow-up of 5.4 years. Adjustments were made for hypertension, diabetes, history of myocardial infarction, hyperlipidemia, age, sex, smoking, and body mass index. Patients with psoriasis were classified as severe if they ever received a systemic therapy. Up to 5 controls without psoriasis were randomly selected from the same practices and start dates as the patients with psoriasis. A total of 556,995 control patients and patients with mild (n = 127,139) and severe psoriasis (n = 3837) were identified. Incident MI. There were 11,194 MIs (2.0%) within the control population and 2319 (1.8%) and 112 (2.9%) MIs within the mild and severe psoriasis groups, respectively. The incidences per 1000 person-years for control patients and patients with mild and severe psoriasis were 3.58 (95% confidence interval [CI], 3.52-3.65), 4.04 (95% CI, 3.88-4.21), and 5.13 (95% CI, 4.22-6.17), respectively. Patients with psoriasis had an increased adjusted relative risk (RR) for MI that varied by age. For example, for a 30-year-old patient with mild or severe psoriasis, the adjusted RR of having an MI is 1.29 (95% CI, 1.14-1.46) and 3.10 (95% CI, 1.98-4.86), respectively. For a 60-year-old patient with mild or severe psoriasis, the adjusted RR of having an MI is 1.08 (95% CI, 1.03-1.13) and 1.36 (95% CI, 1.13-1.64), respectively. Psoriasis may confer an independent risk of MI. The RR was greatest in young patients with severe psoriasis.
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            Psoriasis severity and the prevalence of major medical comorbidity: a population-based study.

            Howa Yeung, Junko Takeshita, Nehal N Mehta … (2013)
            Despite the growing literature on comorbidity risks in psoriasis, there remains a critical knowledge gap on the degree to which objectively measured psoriasis severity may affect the prevalence of major medical comorbidity. To examine the prevalence of major medical comorbidity in patients with mild, moderate, or severe psoriasis, classified objectively based on body surface area involvement, compared with that in patients without psoriasis. Population-based cross-sectional study of patient data from United Kingdom-based electronic medical records; analysis included 9035 patients aged 25 to 64 years with psoriasis and 90,350 age- and practice-matched patients without psoriasis. Prevalence of major medical comorbidity included in the Charlson comorbidity index. Among patients with psoriasis, 51.8%, 35.8%, and 12.4%, respectively, had mild, moderate, or severe disease based on body surface area criteria. The mean Charlson comorbidity index was increasingly higher in patients with mild (0.375 vs 0.347), moderate (0.398 vs 0.342), or severe psoriasis (0.450 vs 0.348) (each P < .05). Psoriasis overall was associated with higher prevalence of chronic pulmonary disease (adjusted odds ratio, 1.08; 95% CI, 1.02-1.15), diabetes mellitus (1.22; 1.11-1.35), diabetes with systemic complications (1.34; 1.11-1.62), mild liver disease (1.41; 1.12-1.76), myocardial infarction (1.34; 1.07-1.69), peptic ulcer disease (1.27; 1.03-1.58), peripheral vascular disease (1.38; 1.07-1.77), renal disease (1.28; 1.11-1.48), and rheumatologic disease (2.04; 1.71-2.42). Trend analysis revealed significant associations between psoriasis severity and each of the above comorbid diseases (each P < .05). The burdens of overall medical comorbidity and of specific comorbid diseases increase with increasing disease severity among patients with psoriasis. Physicians should be aware of these associations in providing comprehensive care to patients with psoriasis, especially those presenting with more severe disease.
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              Risk of moderate to advanced kidney disease in patients with psoriasis: population based cohort study

              Joy Wan, SHUWEI WANG, Kevin Haynes … (2013)
              Objective To determine the risk of chronic kidney disease in patients with psoriasis. Design Population based cohort study and nested cross sectional study. Setting Electronic medical records database based in United Kingdom. Participants Cohort study: patients with psoriasis aged 18-90 each matched to up to five patients without psoriasis based on age, practice, and time of visit. Nested study: patients with psoriasis aged 25-64 with confirmed data on psoriasis severity, each matched to up to 10 patients without psoriasis based on age and practice. Main outcome measures Cohort study: incident moderate to advanced (stage 3 through 5) chronic kidney disease. Nested study: baseline prevalence of chronic kidney disease. Results 136 529 patients with mild psoriasis and 7354 patients with severe psoriasis based on treatment patterns were matched to 689 702 unaffected patients. The adjusted hazard ratios (95% confidence intervals) for incident chronic kidney disease were 1.05 (1.02 to 1.07), 0.99 (0.97 to 1.02), and 1.93 (1.79 to 2.08) in the overall, mild, and severe psoriasis groups, respectively. Age was a significant effect modifier in the severe psoriasis group, with age specific adjusted hazard ratios (95% confidence intervals) of 3.82 (3.15 to 4.64) and 2.00 (1.86 to 2.17) for patients aged 30 and 60, respectively. In the nested analysis of 8731 patients with psoriasis with measurements of affected body surface area matched to 87 310 patients without psoriasis, the adjusted odds ratios (95% confidence intervals) for chronic kidney disease were 0.89 (0.72 to 1.10), 1.36 (1.06 to 1.74), and 1.58 (1.07 to 2.34) in the mild, moderate, and severe psoriasis groups, respectively. Conclusions Moderate to severe psoriasis is associated with an increased risk of chronic kidney disease independent of traditional risk factors.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian Dermatol Online J
                Journal ID (iso-abbrev): Indian Dermatol Online J
                Journal ID (publisher-id): IDOJ
                Title: Indian Dermatology Online Journal
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Print): 2229-5178
                ISSN (Electronic): 2249-5673
                Publication date Collection: Nov-Dec 2021
                Publication date (Electronic): 22 November 2021
                Volume: 12
                Issue: 6
                Pages: 864-867
                Affiliations
                [1] Department of Dermatology and Venereology, Government Medical College, Kottayam, Kerala, India
                [1 ] Department of Dermatology and Venereology, Government Medical College, Manjeri, Kerala, India
                [2 ] Consultantin Dermatology, Dermasurge Skin, Hair and Surgery Clinic, Bengaluru, Karnataka, India
                Author notes
                Address for correspondence: Dr. Sandhya George, Puthussery House, Prasannapuram, Chowara PO - 683571, Ernakulam District, Kerala, India. E-mail: drsandhyageorge@ 123456gmail.com
                Article
                Publisher ID: IDOJ-12-864
                DOI: 10.4103/idoj.IDOJ_887_20
                PMC ID: 8653745
                SO-VID: 1f66534f-9cd7-4a73-8700-9f1827b725c5
                Copyright © Copyright: © 2021 Indian Dermatology Online Journal
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 04 December 2020
                Date revision received : 04 March 2021
                Date accepted : 24 June 2021
                Categories
                Subject: Brief Report

                ScienceOpen disciplines: Dermatology
                Keywords: chronic kidney disease,duration,psoriasis,renal failure,severity
                Data availability:
                ScienceOpen disciplines: Dermatology
                Keywords: chronic kidney disease, duration, psoriasis, renal failure, severity

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