Incidence of bullous pemphigoid and risk of mortality in the dialysis population: A retrospective cohort study

Liles, Jenny E.; Waller, Jennifer L.; Davis, Loretta S.

doi:10.1016/j.jaad.2022.01.046

Cited by 3 publications

(8 citation statements)

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“…Moreover, confounding factors that may interfere with the results were not adjusted for. 12 A potential explanation for the predisposition of dialysis patients to develop bullous pemphigoid includes renal failurerelated immune dysfunction and the Koebner or isomorphic phenomenon. Renal failure itself and the interaction of blood with a bio-incompatible dialysis membrane cause chronic microinflammation, reduction of regulatory T cells, and activation of the complement system, and trigger oxidative stress.…”

Section: Ta B L Ementioning

confidence: 99%

“…However, these studies could not establish a clear causal relationship because of the study design limitations. Furthermore, Liles et al used the US Renal Data System Medicare claims data to calculate the incidence of bullous pemphigoid in dialysis patients and concluded that the incidence of bullous pemphigoid in the dialysis population might be much higher than that in the general population 12 . However, the data of the comparison group were quoted from previous reports from different countries and eras in the literature, and the results were therefore imprecise.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, Liles et al used the US Renal Data System Medicare claims data to calculate the incidence of bullous pemphigoid in dialysis patients and concluded that the incidence of bullous pemphigoid in the dialysis population might be much higher than that in the general population. 12 However, the data of the comparison group were quoted from previous reports from different countries and eras in the literature, and the results were therefore imprecise. Whether or not renal failure and dialysis are independent risk factors for bullous pemphigoid and pemphigus remains unknown and requires clarification, therefore we conducted a nationwide population-based study to investigate the risk of bullous pemphigoid and pemphigus in patients undergoing chronic dialysis.…”

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confidence: 99%

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Risk of bullous pemphigoid and pemphigus in patients on chronic dialysis: A nationwide population‐based cohort study

Tang,

Sue,

Chang

et al. 2023

The Journal of Dermatology

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Bullous pemphigoid has a high incidence among dialysis patients. However, whether or not chronic dialysis is an independent risk factor of bullous pemphigoid remains unclear. We aimed to investigate the effect of chronic dialysis on the development of bullous pemphigoid and pemphigus. We performed a retrospective cohort study using records from Taiwan's National Health Insurance Research Database between 2008 and 2019. We identified a dialysis cohort that included patients on chronic hemodialysis and peritoneal dialysis, and the hazard ratios (HRs) for bullous pemphigoid and pemphigus were compared with those of a sex‐, age‐, and index‐matched cohort, then the results were adjusted for various confounding factors. Among 93 538 patients on chronic dialysis and 93 538 patients in the control group, 287 and 139 developed incident bullous pemphigoid, and 45 and 35 developed incident pemphigus after a median follow‐up of 3.7 and 5.6 years, respectively. The incidence rates of bullous pemphigoid in the dialysis patients and the control group were 74.2 and 25.2 per 100 000 person‐years, respectively (difference between groups, P < 0.0001). The incidence rates of pemphigus in the dialysis patients and the control group were 11.6 and 6.3 per 100 000 person‐years, respectively (difference between groups, P < 0.01). Cox proportional hazard adjustment showed the HR for bullous pemphigoid in dialysis patients was 2.12 (95% confidence interval [CI] 1.64–2.74, P < 0.0001) compared with the control group. Dialysis patients aged <75 years had an even higher risk of bullous pemphigoid development (5‐ to 8‐fold) than the control group. The adjusted HR for pemphigus was not elevated in dialysis patients (adjusted HR 1.52, 95% CI 0.87–2.67, P = 0.14). Chronic dialysis is an independent risk factor for developing bullous pemphigoid, but not a risk factor for pemphigus. Physicians should be aware of the predisposition of chronic dialysis patients to bullous pemphigoid.

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Section: Ta B L Ementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk of bullous pemphigoid and pemphigus in patients on chronic dialysis: A nationwide population‐based cohort study

Tang,

Sue,

Chang

et al. 2023

The Journal of Dermatology

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“…Because there is a greater chance of infection, psoriasis therapies have been deemed by experts to be too risky for use in individuals with kidney disease. However, three individuals were given ustekinumab treatment by Japanese experts [41][42][43]. All patients saw improvement in their psoriasis symptoms, and the majority of them accepted the medication well.…”

Section: Dialysis's Effects On Patients With and Without Kidney Disea...mentioning

confidence: 99%

“…Europe's data show little difference among nations, with rates like 1.45% (Croatia), 1.60% (Norway), and 1.4% (UK). Only 0.7% of people in East Africa and 0.7% of people in China's Henan district were determined to be affected [39][40][41]. According to their treatment preferences, 136,529 persons with mild psoriasis and 7,354 people with severe psoriasis were matched with 689,702 unaffected people in a population-based cohort analysis and nested cross-sectional study carried out in the UK.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Dialysis in Psoriasis: A Short Review

Pandey¹,

Kumar²

2022

Cureus

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Psoriasis is a chronic, incurable condition with an erratic course of symptoms and triggers by nature. Psoriasis patients need medical attention that extends beyond only treating skin conditions and joint issues. Because psoriasis is so complex, treating it with medication alone does not work well; comprehensive, whole-person treatment is required. Screening for concomitant diseases including hypertension, dyslipidemia, diabetes mellitus, cardiovascular issues, and their adverse effects like myocardial infarction and stroke is a part of treating psoriasis. Regular screening for these linked illnesses should be done. Essential elements of psoriasis care include co-medication to avoid drug interactions or drug-induced psoriasis, as well as the identification and management of trigger factors. The lack of widely used and established diagnostic criteria restricts these studies. Essential elements of psoriasis management include routine screening for these associated disorders, co-medication to avoid drug interactions or psoriasis caused by drugs, as well as the identification of trigger factors and their management. This short review highlights the effectiveness of dialysis in people with psoriasis and the fact that the benefit is more pronounced with peritoneal dialysis than with hemodialysis.

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Pemphigoid diseases in patients with end-stage kidney diseases: pathogenesis and treatment

Yang,

Wang,

Zuo

2024

Front. Immunol.

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BackgroundPemphigoid diseases constitute a group of autoimmune blistering disorders characterized by subepithelial blistering. The association between pemphigoid diseases and both end-stage kidney disease (ESKD) and its treatment is notable. However, there is limited evidence about the management of pemphigoid diseases in patients with ESKD. This systematic review compiled case reports and relevant studies, summarized the underlying mechanisms of pemphigoid diseases in patients with ESKD, and summarized the efficacy of various therapies.MethodsA systematic search of PubMed and Embase was performed for articles published between 1982 to June 2, 2024.ResultsFifty-three case reports and eight relevant studies were included. Triggers for pemphigoids in patients with ESKD included materials used to treat ESKD, immune dysregulation of patients with ESKD, and rejection of renal allograft. Treatment for these patients included removing triggers, as well as administering of corticosteroids, mycophenolate mofetil (MMF), tetracyclines, rituximab, methotrexate, dapsone, azathioprine, cyclosporine, intravenous immunoglobin (IVIG), plasmapheresis, and Janus kinase inhibitors.ConclusionRemoving triggers is the most effective strategy. Despite their suboptimal efficacy, corticosteroids remain the most commonly used agents in this patient population. MMF, tetracyclines, and rituximab are less used but with benefits. There are significant adverse effects associated with methotrexate treatment. Other treatment may also be beneficial and require further investigation. These findings may enable clinicians to optimize the therapeutic approach for these patients.

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Incidence of bullous pemphigoid and risk of mortality in the dialysis population: A retrospective cohort study

Cited by 3 publications

References 4 publications

Risk of bullous pemphigoid and pemphigus in patients on chronic dialysis: A nationwide population‐based cohort study

Risk of bullous pemphigoid and pemphigus in patients on chronic dialysis: A nationwide population‐based cohort study

Effectiveness of Dialysis in Psoriasis: A Short Review

Pemphigoid diseases in patients with end-stage kidney diseases: pathogenesis and treatment

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