Risk of chronic kidney disease and end-stage renal disease in patients with psoriasis: A systematic review and meta-analysis of cohort studies

Abstract

Background: Previous studies showed a higher risk of renal disease among patients with psoriasis; however, this association has been inconsistent. Objectives: This study aimed to carry out a comparison in the probability from suffering renal diseases—including chronic kidney disease (CKD), end-stage renal disease (ESRD), IgA nephropathy (IgAN), glomerular disease (GD), and those resulting in death caused by other renal diseases—in patients with psoriasis. Methods: The systematic review and meta-analysis was conducted to identify cohort studies with reported hazard ratios (HRs) and a 95% confidence intervals (CIs) for the renal outcomes among patients with psoriasis. The meta-analysis was analyzed with the random-effects modeling and was further stratified by psoriasis severity. Results: Three studies were included. Compared to controls without psoriasis, patients with psoriasis had increased risks of CKD (HR: 1.53; 95% CI: 1.20–1.96) and ESRD (HR: 1.24, 95% CI: 1.06–1.46). The risks of CKD (HR: 1.91, 95% CI: 1.78–2.05) and ESRD (HR: 2.72, 95% CI: 1.71–4.34) were increased in servere psoriasis patients. Due to substantial heterogeneity across enrolled studies (I2 = 95%), the risk of CKD in mild psoriasis was insignificant (HR: 1.14, 95% CI 0.87–1.48). Two studies identified severe psoriasis were related to higher risks of IgAN and GD, whereas one study found that mild psoriasis was associated with an increased risk of death from renal disease. Conclusion: Patients with severe psoriasis have a higher risk of incident CKD, ESRD, and GD. However, we only identified two cohort studies that compared the risk of IgAN and GD in psoriasis patients to general populations. It is difficult to conclude that severe psoriasis was associated with higher risks of IgAN and GD. For mild psoriasis, the association with renal disease was less consistent.