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. 2013 Oct 15:347:f5961.
doi: 10.1136/bmj.f5961.

Risk of moderate to advanced kidney disease in patients with psoriasis: population based cohort study

Joy Wan  1 , Shuwei Wang, Kevin Haynes, Michelle R Denburg, Daniel B Shin, Joel M Gelfand
Affiliations

Risk of moderate to advanced kidney disease in patients with psoriasis: population based cohort study

Joy Wan et al. BMJ. .

Abstract

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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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: MRD has received research grants from the NephCure Foundation-American Society of Nephrology and the National Kidney Foundation/Amgen KDOQI research fellowship; JMG has received research grants from Amgen, Abbvie, Eli Lilly, and Novartis and honorariums from Abbvie, Jansen, Novartis, Eli Lilly, and Pfizer; JMG chairs the data and safety monitoring boards for Celgene and Merck.

Figures

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Fig 1 Adjusted relative risk of chronic kidney disease in patients with psoriasis based on patient age
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Fig 2 Adjusted prevalence odds ratio of chronic kidney disease in patients with psoriasis based on severity according to % body surface area (BSA) affected
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