Psoriasis and Its Impact on In-Hospital Outcome in Patients Hospitalized with Acute Kidney Injury

Abstract

Background: Psoriasis is a chronic inflammatory disease which affects the body far beyond the skin. Whereas there is solid evidence that chronic skin inflammation in psoriasis drives cardiovascular disease, the impact on renal impairment and acute kidney injury (AKI) is still unclear. We aimed to analyze the impact of psoriasis on the in-hospital outcome of patients hospitalized with AKI. Methods: In this retrospective database study, we investigated data on characteristics, comorbidities, and in-hospital outcomes for all hospitalized patients with AKI stratified for concomitant psoriasis, which were collected by the Federal Office of Statistics in Germany between 2005 and 2016. Results: Among the 3,162,449 patients treated for AKI in German hospitals between 2005 and 2016, 11,985 patients (0.4%) additionally suffered from psoriasis. While the annual number of AKI patients with psoriasis increased significantly from 485 cases (4.0%) in 2005 to 1902 (15.9%) in 2016 (p < 0.001), the in-hospital mortality decreased substantially (from 24.9% in 2005 to 17.4% in 2016; p < 0.001). AKI patients with concomitant psoriasis were younger (70 (IQR; 60–78) vs. 76 (67–83) years; p < 0.001) and were more often treated with dialysis (16.3% vs. 13.6%, p < 0.001). Presence of psoriasis in AKI patients was associated with reduced prevalence of myocardial infarction (OR 0.62; p < 0.001), stroke (OR 0.85; p = 0.013), and in-hospital mortality (OR 0.75; p < 0.001). Conclusions: AKI patients with psoriasis were hospitalized in median 6 years earlier than those without. Despite younger age, we detected higher use of kidney replacement therapy in patients with psoriasis, indicating a more severe course of AKI. Our findings might improve management of these patients and contribute evidence for extracutaneous, systemic manifestations of psoriasis.

Case-Fatality and Temporal Trends in Patients with Psoriasis and End-Stage Renal Disease

“…In line with the literature [ 3 ], our data indicate that psoriasis patients are at risk for developing chronic kidney disease together with all crucial cardiovascular risk factors and subsequent cardiovascular disease at earlier stages in their lifetime. We have previously shown that CKD stages 2, 3, and 5 were more common in a cohort of AKI patients with psoriasis, despite a significantly younger age of the patients—on average about 5 years as well [ 27 ]. With the current data, we are able to confirm these findings: psoriasis patients hospitalized with acute- or end-stage renal failure are significantly younger than patients in the same cohort without psoriasis.…”

Kynurenine Pathway in Psoriasis—a Promising Link?

“…Furthermore, data show that psoriatic patients were hospitalized with acute kidney injury at a median 6 years earlier compared to a group without dermatosis [ 5 ]. The possible explanation is the increased risk of cardiovascular diseases among patients with psoriasis and higher chances of developing those diseases earlier compared to the general population [ 5 ].…”

“…Furthermore, data show that psoriatic patients were hospitalized with acute kidney injury at a median 6 years earlier compared to a group without dermatosis [ 5 ]. The possible explanation is the increased risk of cardiovascular diseases among patients with psoriasis and higher chances of developing those diseases earlier compared to the general population [ 5 ]. Gonzalez-Parra et al highlighted that patients with psoriasis suffer from atherosclerosis, hypertension, dyslipidaemia and diabetes—which are known to increase cardiovascular risk—more often than the general population [ 28 ].…”

“…Among patients with psoriatic diseases such as Crohn’s disease, psychiatric disorders, renal diseases and cardiometabolic syndrome (CMDs) are diagnosed more often than in the general population [ 3 , 4 ]. It was noted that patients with psoriasis were hospitalized with acute kidney injury at a younger aged compared to a group without this disease [ 5 ]. Other studies highlight the fact that drugs used for treatment of psoriasis are nephrotoxic [ 4 ].…”

Ixekizumab May Improve Renal Function in Psoriasis

“…Additionally, patients with renal problems have a higher risk of developing psoriasis [ 4 ]. The severity of renal impairment is usually linked with the psoriatic condition’s severity [ 5 ]. Various treatments have been proposed for the management of this condition.…”