Psoriasis Tied to Kidney Disease in T2D, Despite Treatment
Patients with type 2 diabetes (T2D) who have psoriasis showed an increased risk for renal disease, including diabetic neuropathy, chronic kidney disease (CKD), end-stage renal disease (ESRD), and dialysis despite renoprotective therapy, while CKD risk had increased at 10 years after starting treatment among those receiving biologics.
METHODOLOGY:
Researchers conducted a retrospective cohort analysis using TriNetX data from 2014-2024, which included patients with T2D who started treatment with angiotensin-converting enzyme inhibitors (ACEis), angiotensin II receptor blockers (ARBs), or sodium-glucose cotransporter-2 inhibitors (SGLT2is).
After propensity score matching, 27,044 patients were included in two cohorts — with and without psoriasis, diagnosed before starting renoprotective therapy.
A total of 7771 patients with psoriasis received biologics, including interleukin (IL)-23, IL-17, IL-12/23, or tumor necrosis factor (TNF) alpha inhibitors.
Study outcomes were diabetic nephropathy, CKD, ESRD, and need for dialysis at 3, 5, and 10 years.
TAKEAWAY:
At 3 years, patients with psoriasis demonstrated a significantly higher risk for diabetic nephropathy (absolute risk increase [ARI], 1.31; P < .0001), CKD (ARI, 1.80; P < .0001), ESRD (ARI, 0.38; P < .0001), and dialysis (ARI, 0.28; P < .0001).
< .0001), CKD (ARI, 1.80; < .0001), ESRD (ARI, 0.38; < .0001), and dialysis (ARI, 0.28; < .0001). The increased risk persisted at 5 years (ARI, 2.02, 3.28, 0.58, 0.42, respectively; all P < .0001), and at 10 years (ARI, 3.30, 6.33, 0.94, 0.63, respectively; all P < .0001).
< .0001), and at 10 years (ARI, 3.30, 6.33, 0.94, 0.63, respectively; all < .0001). Patients with psoriasis who received biologics showed a higher risk for CKD at 10 years despite renoprotective therapy ( P < .0001) than those without psoriasis.
IN PRACTICE:
'Psoriasis may trigger a T-helper-17-driven inflammatory response, leading to the production of cytokines such as IL-17, IL-12/23, and TNF,' which induce renal inflammation, and this process is 'not targeted by ACEis, ARBs, or SGLT2is,' which may explain the persistently elevated CKD risk in patients with both T2DM and psoriasis, according to the study authors. They added that the findings support earlier evidence that 'biologics do not ameliorate the deterioration of renal function' in those with existing renal issues and a prospective study is needed to confirm these associations.
SOURCE:
The study was led by Tarun Sontam, Texas A&M School of Medicine, Dallas, Texas, and was published online on May 7 in the Journal of the American Academy of Dermatology .
LIMITATIONS:
The study did not account for psoriasis severity or duration and adherence to renoprotective therapy. The authors noted that uncontrolled factors might influence the findings.
DISCLOSURES:
The authors reported having no conflicts of interest. The study had no funding source.
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