News & Perspective
T2DM patients with psoriasis face higher risk of CKD despite standard treatments
CKD is a major complication of T2DM and current guidelines advocate for early treatment using renoprotective therapies such as ACEIs, ARBs, or SGLT2Is to reduce albuminuria and delay disease progression.2,3 However, psoriasis itself is an independent risk factor for CKD, potentially driven by immune-mediated mechanisms, and is not addressed by conventional renal therapies.1,2 This retrospective cohort study evaluated whether psoriasis increases the risk of diabetic nephropathy, CKD, ESRD, and the need for dialysis in patients with T2DM receiving renoprotective therapies.2
In the retrospective study, electronic health record data from the TriNetX research network between 2014 and 2024 were used to identify patients aged 18-90 who initiated ACEIs, ARBs, or SGLT2i therapy after a diagnosis of T2DM, using ICD-10, CPT, and RxNorm codes.2 Individuals with pre-existing nephropathy, CKD, or ESRD before T2DM or psoriasis diagnosis and initiation of renoprotective therapies were excluded from the study.2 Propensity score matching (PSM) was employed to balance covariates, resulting in two matched cohorts of 27,044 patients each.2 One of the cohorts included patients with a diagnosis of psoriasis prior to the initiation of renoprotective treatment, while the other included those without psoriasis.2 The matching process controlled for baseline characteristics, comorbidities, and medication history.2 The cohorts were assessed for the risk of diabetic nephropathy, CKD, ESRD, and dialysis at 3-, 5-, and 10-year intervals following initiation of renoprotective therapies.2
Compared to T2DM patients without psoriasis, those with psoriasis had significantly higher rates of diabetic nephropathy, CKD, ESRD, and need for dialysis at 3-, 5-, and 10-year
follow-ups (all p<0.0001).2 At 10 years, the incidence of CKD was 8.73% in the psoriasis cohort vs. 2.41% in controls, while ESRD rates were 1.34% vs. 0.40%, respectively (all p<0.0001).2 Notably, among 7,771 psoriasis patients receiving biologic therapy, the risk of CKD remained significantly elevated at 10 years (p<0.0001) as compared to patients without psoriasis, despite concurrent use of renoprotective therapy.2
Psoriasis may lead to persistent T-helper-17-driven systemic inflammation, resulting in elevated production of cytokines such as interleukin-17 (IL-17), interleukin-23 (IL-23) and tumor necrosis factor-alpha (TNF-α), which impair renal hemodynamics, stimulate T-lymphocyte infiltration and promote inflammatory kidney injury.2 Since ACEis, ARBs, and SGLT2is do not target these inflammatory pathways, standard renoprotective strategies may be insufficient to reduce CKD risk in T2DM patients with psoriasis as compared to those without psoriasis, potentially explaining the increased risk observed despite guideline-directed therapy.2 Furthermore, the findings align with previous evidence showing that biologic therapies do not appear to effectively ameliorate deterioration of renal function in psoriasis patients with underlying renal dysfunction such as microalbuminuria.2
Although strengthened by large cohort size and rigorous matching methods, the study is limited by reliance on ICD-10, CPT, and RxNorm coding, which may not reflect psoriasis severity, duration, or adherence to renoprotective therapy.2 Despite efforts to eliminate bias, residual confounding factors may still affect the results.2 Nonetheless, the results provide compelling preliminary evidence supporting psoriasis as a relevant factor in renal outcomes for T2DM populations.2
