Psoriasis Linked to Higher Risk of Kidney Disease in Diabetics, Even with Biologic Therapy: Study

The study reveals that patients with both T2D and psoriasis face a significantly elevated risk of developing renal conditions, including diabetic nephropathy, chronic kidney disease (CKD), end-stage renal disease (ESRD), and the need for dialysis. This increased risk persists over time despite treatment with commonly used kidney-protective medications such as ACE inhibitors, ARBs, and SGLT2 inhibitors, as well as newer biologic agents.

Researchers utilized real-world data from the TriNetX platform, spanning 10 years from 2014 to 2024. The analysis included 27,044 patients with type 2 diabetes, divided into two matched cohorts based on psoriasis diagnosis before initiation of renoprotective therapy. Among them, 7,771 patients with psoriasis had also been treated with biologics targeting IL-23, IL-17, IL-12/23, or TNF-alpha.

The study revealed the following findings:

• Patients with psoriasis consistently showed a higher absolute risk for renal complications over time.
• At 3 years, the psoriasis group had increased risk for diabetic nephropathy (ARI 1.31%), CKD (1.80%), ESRD (0.38%), and dialysis (0.28%), all statistically significant.
• At 5 years, these risks further rose to 2.02% for diabetic nephropathy, 3.28% for CKD, 0.58% for ESRD, and 0.42% for dialysis.
• By 10 years, the risks continued to escalate—3.30% for diabetic nephropathy, 6.33% for CKD, 0.94% for ESRD, and 0.63% for dialysis.
• Even patients on biologic therapy demonstrated a significantly increased risk of CKD at the 10-year mark, indicating these treatments may not sufficiently prevent renal decline.

The study authors suggest that the link may be rooted in the inflammatory nature of psoriasis, particularly the T-helper-17-driven immune response. Cytokines like IL-17, IL-12/23, and TNF-alpha are believed to promote renal inflammation, a process not fully mitigated by current renoprotective medications.

“These findings highlight a persistent and under-recognized risk,” the authors noted, emphasizing the need for more tailored treatment strategies for patients coping with psoriasis and diabetes. They also call for prospective studies to better understand the underlying mechanisms and to evaluate potential interventions that could prevent kidney deterioration in this vulnerable group.

Reference:

Sontam T, Cho SW, Chen A, Chen H, Raman J, Tarbox M. Psoriasis is Associated with an Increased Risk of Chronic Kidney Disease in Diabetic Patients Despite Renoprotective or Biologic Therapy: A Retrospective Cohort Study. J Am Acad Dermatol. 2025 May 7:S0190-9622(25)00710-8. doi: 10.1016/j.jaad.2025.03.098. Epub ahead of print. PMID: 40345551.