|Title:||Increased risk of glomerulonephritis and chronic kidney disease in relation to the severity of psoriasis, concomitant medication, and comorbidity: A nationwide population-based cohort study||Authors:||SUNG-JAN LIN||Keywords:||azathioprine; cyclosporin A; etretin; methotrexate; nonsteroid antiinflammatory agent; nonsteroid antiinflammatory agent, adult; aged; arthritis; Article; chronic kidney disease; clinical evaluation; cohort analysis; comorbidity; controlled study; disease association; disease severity; female; follow up; glomerulonephritis; human; investigative procedures; major clinical study; male; middle aged; patient identification; patient selection; prevalence; priority journal; psoriasis; randomized controlled trial; risk factor; adolescent; age distribution; complication; epidemiology; glomerulonephritis; psoriasis; Renal Insufficiency, Chronic; socioeconomics; Taiwan; young adult, Adolescent; Adult; Age Distribution; Aged; Anti-Inflammatory Agents, Non-Steroidal; Epidemiologic Methods; Female; Glomerulonephritis; Humans; Male; Middle Aged; Psoriasis; Renal Insufficiency, Chronic; Socioeconomic Factors; Taiwan; Young Adult||Issue Date:||2015||Publisher:||Blackwell Publishing Ltd||Journal Volume:||173||Journal Issue:||1||Start page/Pages:||146-54||Source:||British Journal of Dermatology||Abstract:||
Background Few studies have examined the association between psoriasis and glomerulonephritis (GN) as well as chronic kidney disease (CKD). Objectives To determine the risk of CKD in patients with psoriasis and evaluate the impact of the severity of psoriasis, comorbidities and concomitant drugs on the risk of GN and CKD in patients with psoriasis. Methods We identified 4344 patients with psoriasis for the study cohort and randomly selected 13 032 subjects as a control cohort. Each subject was individually followed for up for 5 years to identify those who subsequently developed GN and CKD. Results After adjustment for traditional CKD risk factors, psoriasis was found to be independently associated with an increased risk of CKD during the follow-up period [hazard ratio (HR) 1·28; 95% confidence interval (CI) 1·14-1·44]. The increased incidence of GN in patients with psoriasis (HR 1·50, 95% CI 1·24-1·81) may contribute to the positive association between psoriasis and CKD. Patients with mild and severe psoriasis had an increased risk of CKD and GN compared with the control cohort; the risk increased with severity. Patients with psoriasis and arthritis exhibited a higher risk of CKD than patients without arthritis (HR 1·62 vs. 1·26). Among drugs, nonsteroidal anti-inflammatory drugs (NSAIDs) have the strongest association with CKD in patients with psoriasis (adjusted odds ratio 1·69, 95% CI 1·14-2·49). Conclusions Psoriasis was associated with a higher risk of developing CKD and GN. High severity, psoriatic arthritis involvement and concomitant NSAIDs use further increased the risk of CKD in patients with psoriasis. What's already known about this topic? There is an increased risk of multiple comorbidities in patients with psoriasis. What does this study add? Both mild and severe psoriasis presented an increased risk of chronic kidney disease (CKD) and glomerulonephritis, independent of traditional risk factors for CKD. The development of CKD in patients with psoriasis was multifaceted. High severity, psoriatic arthritis involvement and concomitant nonsteroidal anti-inflammatory drug use further increased the risk of CKD in patients with psoriasis. © 2014 British Association of Dermatologists.
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