Previous research in non-dialysis patients suggests that the inflammatory skin disease psoriasis is associated with an increased risk of severe vascular events like myocardial infarction (MI). Thus, we determined whether psoriasis represents a significant risk factor for MI in end-stage renal disease (ESRD) patients.
We queried the United States Renal Data System for ESRD patients starting dialysis between 2004 and 2015. ICD-9 and ICD-10 codes were used to identify those with at least two diagnoses of psoriasis, a diagnosis of MI, and other clinical risk factors. Logistic regression was used to examine the association of psoriasis and various risk factors with MI.
Of a cohort of 1,062,693, we identified 6823 (0.6%) subjects with psoriasis and 181,960 (17.1%) with MI. Of the 6823 patients with psoriasis, 1671 (24%) developed an MI. Psoriasis was associated with an increased risk of MI in an unadjusted model [odds ratio (OR) = 1.34; confidence interval (CI) = 1.26–1.42]. However, after controlling for demographics, dialysis modality, access type, and various conditions related to the Charlson Comorbidity Index, psoriasis was not associated with MI (OR = 0.95, CI = 0.89–1.01). Confounders of the association of psoriasis with MI included congestive heart failure (OR = 5.26, CI = 5.17–5.36), pulmonary disease (OR = 1.25, CI = 1.23–1.26), and diabetes with complications (OR = 1.82, CI = 1.79–1.85).
Contrary to prior research in the general population, in the ESRD population psoriasis was not associated with an increased risk of MI after controlling for various demographic and clinical parameters. These data emphasize the importance of an integrated approach since comorbidities may influence the choice of therapy for psoriasis and outcomes.
Psoriasis is a chronic inflammatory disease that is characterized by the development of scaly, erythematous plaques on the skin. Approximately 7.4 million people in the United States are affected by psoriasis and its associated comorbidities, which greatly impact quality of life.
Classic comorbidities include psoriatic arthritis, psychological/psychiatric disorders, and uveitis. Psoriasis patients have a greater prevalence of cardiovascular disease risk factors, including hypertension, diabetes, obesity, dyslipidemia, and atherosclerosis. Psoriasis has also been associated with an increased prevalence of severe coronary artery calcification (CAC), with CAC scores elevated to a similar extent as is observed in type II diabetes. , CAC, in turn, is associated with cardiovascular disease, including myocardial infarction (MI). , Furthermore, meta-analysis studies have suggested that psoriasis is associated with an increased risk of severe vascular events, particularly MI. , Inflammation, secretion of adipokines, insulin resistance, enhanced angiogenesis, oxidative stress, and hypercoagulability may contribute to the association between psoriasis and cardiometabolic disorders. Patients with psoriasis are also at significantly increased risk for chronic kidney disease and end-stage renal disease (ESRD). , One possible mechanism proposes that tubular injury may be induced by increased levels of uric acid. , In addition, renal dysfunction may potentially be attributed to comorbidities associated with psoriasis, including atherosclerosis, arterial hypertension, and diabetes. Systemic inflammation may also provide a mechanistic link between psoriasis and kidney disease, as well as cardiometabolic disorders. Patients with severe psoriasis were found to have a 5-year decreased life expectancy, with cardiovascular disease contributing significantly to this disparity. , Psoriasis patients also showed an increased risk of stroke, atherosclerosis, myocardial infarction, coronary artery disease, and endothelial dysfunction even when cardiovascular risk factors were accounted for. , Psoriasis remains undertreated in the ESRD population when compared to the already undertreated general population. Thus, the presence of psoriasis may represent a significant additive risk factor for developing cardiovascular diseases in ESRD patients. To address this question, we queried the United States Renal Data System (USRDS) for ESRD patients with psoriasis to investigate psoriasis as a potential risk factor for myocardial infarction (MI).