Departments of Dermatology and Medical Research, Cardinal Tien Hospital, New Taipei City, Taiwan.
School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
J Dermatol. 2018 Sep;45(9):1063-1070. doi: 10.1111/1346-8138.14531. Epub 2018 Jul 11.
Patients with end-stage renal disease (ESRD) on chronic hemodialysis (HD) experience chronic inflammation and immune dysregulation; whether these affect the development of chronic inflammatory disease such as psoriasis is unknown. We aimed to investigate the impact of ESRD on the development of psoriasis. We performed a retrospective cohort study using records between 1999 and 2013 from Taiwan's National Health Insurance Research Database. Among 74 916 patients with ESRD on chronic HD and the control group comprising 74 916 sex and age group-matched patients, 165 and 81 incident psoriasis developed after a mean follow up of 2.4 and 2.9 years, respectively. The incidence rates of psoriasis in HD patients and the control group were 91.7 and 37.1 per 100 000 person-years, respectively (difference between groups, P < 0.001). HD patients had a shorter time to psoriasis diagnosis than the control group (P < 0.05). Cox proportional hazard adjustment showed the hazard ratio (HR) for psoriasis in HD patients as 2.09 (95% confidence interval [CI], 1.49-2.94; P < 0.001) than that of the control group. Younger HD patients had relatively higher risk of psoriatic development (age <60 years; adjusted HR, 3.68; 95% CI, 1.93-7.02; P < 0.001). The relative risk of psoriatic arthritis was not increased in HD patients compared with the control group. In conclusion, patients with ESRD on chronic HD had a greater risk of developing psoriasis. Physicians should be aware of the predisposition to psoriasis in patients with ESRD on chronic HD.
患有终末期肾病（ESRD）并接受慢性血液透析（HD）的患者经历慢性炎症和免疫失调；这些是否会影响如银屑病等慢性炎症性疾病的发展尚不清楚。我们旨在研究 ESRD 对银屑病发展的影响。我们使用台湾全民健康保险研究数据库在 1999 年至 2013 年间的记录进行了一项回顾性队列研究。在 74916 名接受慢性 HD 的 ESRD 患者和对照组（由 74916 名性别和年龄组匹配的患者组成）中，分别在平均随访 2.4 年和 2.9 年后发生了 165 例和 81 例银屑病新发病例。HD 患者和对照组的银屑病发病率分别为 91.7 和 37.1/10 万人年，组间差异有统计学意义（P < 0.001）。HD 患者比对照组更早诊断出银屑病（P < 0.05）。Cox 比例风险调整显示，HD 患者的银屑病风险比（HR）为 2.09（95%可信区间[CI]，1.49-2.94；P < 0.001）高于对照组。较年轻的 HD 患者发生银屑病的风险相对较高（年龄 <60 岁；调整 HR，3.68；95%CI，1.93-7.02；P < 0.001）。与对照组相比，HD 患者患银屑病关节炎的相对风险并未增加。总之，接受慢性 HD 的 ESRD 患者发生银屑病的风险更高。医生应意识到慢性 HD 的 ESRD 患者发生银屑病的倾向。
