Relationship Between Psoriasis, Kidney Damage Remains Unclear

Although researchers have established that adults with psoriasis are more likely to experience end-stage renal failure and chronic kidney disease (CKD), the connections between these conditions remains murky, according to a recently published article in the Cureus Journal of Medical Science.

Psoriasis is a complex, chronic, incurable condition requiring comprehensive, holistic treatment to manage. Screening for concomitant diseases such as hypertension, dyslipidemia, diabetes, and cardiovascular issues is a part of treating psoriasis. Pharmacists are often involved with co-medication management to avoid drug-drug interactions or drug-induced psoriasis, as well as identifying and managing trigger factors for patients with psoriasis.

Earlier research has investigated the likelihood of chronic renal failure among patients with psoriasis. According to treatment preferences, one study matched 136,529 individuals with mild psoriasis and 7354 individuals with severe psoriasis with 689,702 unaffected patients. Despite the absence of typical risk variables, the resulting analyses found that moderate to severe psoriasis increased the likelihood of chronic renal failure.

Research has also established that adults with psoriasis are more likely to experience end-stage renal failure and CKD, according to the authors of the current study. This coexistence has been frequently documented, resulting in the term “psoriatic nephropathy.” To better understand these links, investigators conducted a literature review to explore the effectiveness of dialysis in patients with psoriasis.

According to the review, a study at Penn State University found that individuals who are affected by psoriasis on more than 3% of their bodies are more at risk for developing kidney diseases. More importantly, regardless of other risk factors that contributed to the condition, moderate to severe psoriasis raises the likelihood of developing CKD or end-stage renal disease.

Notably, reduced immunoglobulin G levels, theorized elimination of chemicals that promote development from the bloodstream, factors connected to psoriasis, polymorphonuclear leukocyte activation, obstruction of neutrophil migration, and increased levels of fibronectin are some factors that may be connected with CKD.

However, several studies have linked the onset of psoriasis to dialysis-induced growth factors, cytokines, and chemokines. Chronic renal disease is independently predicted by severe psoriasis, and studies that concentrate on commonalities between the 2 illnesses may be useful.

The investigators also reviewed study findings regarding the effects of dialysis on patients with and without kidney disease who have psoriasis. In one study, 3 patients with psoriasis who had failed every form of conventional therapy underwent 32 hours of peritoneal dialysis per week for 10 weeks.

According to the study, 80% of the psoriatic lesions in 2 patients disappeared following the course of treatment. The lesions returned in 1 of these patients 2 months later, whereas the other patient remained in relative remission a year later.

In the third patient, 50% of the lesions cleared up, but 2 months after completing treatment the lesions returned. These results do suggest that dialysis may benefit patients with psoriasis and that the benefit is more pronounced with peritoneal dialysis than with hemodialysis.

In another study, continuous ambulatory peritoneal dialysis was used to treat 4 patients with psoriasis. Whereas 2 were only having treatment for their psoriasis and had normal renal function, the other 2 were receiving treatment for renal failure. Three to 4 daily exchanges throughout prolonged therapy may be necessary to achieve an initial full remission, according to the study, and ongoing counseling could be required to prevent relapse.

Finally, the authors reviewed potential reasons to change from conventional psoriasis treatments. Because psoriasis frequently requires lifelong treatment, all options must be both highly effective and safe in the long-term.

Treatment is only available to manage symptoms of psoriasis because the cause is still unknown, and options include a wide range of topical and systemic medications as well as phototherapy. Treatment is also necessary to minimize the pain and disability caused by psoriasis.

Psoriasis and end-stage renal disease are believed to share multiple pathogenic pathways, including various cytokines, reactive oxygen species, and psoriasis medications. However, the study authors noted that their findings need to be verified, the processes causing renal insufficiency in psoriasis need to be discovered, and further research is necessary to determine how treating psoriasis impacts the risk of developing CKD.

REFERENCE

Pandey P and Kumar S. Effectiveness of Dialysis in Psoriasis: A Short Review. Cureus; October 8, 2022. Accessed November 1, 2022. https://www.cureus.com/articles/113836-effectiveness-of-dialysis-in-psoriasis-a-short-review