title: Risk of incident chronic kidney disease and end-stage renal disease in patients with psoriasis: A nationwide population-based cohort study.
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.
authors: Department of Dermatology and Centre for Evidence-Based Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors: Ching-Chi
authors: CC
authors: Chi
authors: Faculty of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan; School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors: Jui
authors: J
authors: Wang
authors: Division for Disease Control and Prevention, Department of Health, Taipei City Government, Taipei, Taiwan; Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan; Department of Nursing, Kang-Ning Junior College of Medical Care and Management, Taipei, Taiwan.
authors: Yu-Fen
authors: YF
authors: Chen
authors: Department of Dermatology, Far Eastern Memorial Hospital, New Taipei, Taiwan.
authors: Shu-Hui
authors: SH
authors: Wang
authors: Faculty of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan.
authors: Fu-Li
authors: FL
authors: Chen
authors: Faculty of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan; Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei, Taiwan. Electronic address: ch2876@chgh.org.tw.
authors: Tao-Hsin
authors: TH
authors: Tung
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000150:complications*; D012307:Risk Factors
keywords: Chronic kidney disease; End-stage renal disease; Psoriasis; Psoriatic arthritis