Treatment of psoriasis in end-stage renal disease patients is associated with decreased mortality: A retrospective cohort study

Am J Med Sci. 2021 Jul;362(1):24-33. doi: 10.1016/j.amjms.2021.03.009. Epub 2021 Mar 30.


Background: Psoriasis impairs the quality of life of approximately 7.5 million Americans and is associated with serious comorbidities. Because of chronic vascular access and epidermal dysfunction, end-stage renal disease (ESRD) patients with psoriasis may be at greater risk for infection, and psoriasis treatment could affect this risk.

Methods: A retrospective cohort analysis was performed using the United States Renal Data System from 2004-2011 to investigate the association of psoriasis with infections common to ESRD patients, as well as the effect of psoriasis treatment on infection risk as well as mortality.

Results: A total of 8,911 psoriasis patients were identified. Psoriasis was associated with a significantly increased risk for all queried infections, especially cellulitis (adjusted relative risk = 1.55), conjunctivitis (1.47), and onychomycosis (1.36). Psoriasis treatment (systemic, local, and light) was associated with a significantly decreased risk of some infections. Psoriasis treatment was also correlated with a significantly decreased risk of mortality, with systemic therapies (biologics and other immunosuppressants) showing the greatest reduction (adjusted hazard ratio = 0.55).

Conclusions: These results suggest that psoriasis-ESRD patients may have an increased risk of infection and treatment of psoriasis is associated with a reduced risk of some infections and improved survival.

Keywords: Dialysis; End-stage renal disease; Epidemiology; Psoriasis; USRDS.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage
  • Aged
  • Cohort Studies
  • Databases, Factual / trends
  • Dermatologic Agents / administration & dosage
  • Female
  • Humans
  • Kidney Failure, Chronic / drug therapy*
  • Kidney Failure, Chronic / mortality*
  • Male
  • Middle Aged
  • Mortality / trends
  • Psoriasis / drug therapy*
  • Psoriasis / mortality*
  • Retrospective Studies
  • Skin Diseases, Infectious / drug therapy*
  • Skin Diseases, Infectious / mortality*


  • Adrenal Cortex Hormones
  • Dermatologic Agents