The researchers have called for more investigation into why current treatments might not provide strong protection.
Patients with type 2 diabetes mellitus and psoriasis face significantly higher long-term risks of diabetic nephropathy, chronic kidney disease, end-stage renal disease and dialysis, a large retrospective cohort study has found.
And the risk remains even if patients are being treated with guideline-recommended reno-protective therapies, the researchers say.
The study, published as a letter to the editor in the Journal of the American Academy of Dermatology, was based on data from over 54,000 patients in the TriNetX database over an 11-year period.
“Psoriasis is associated with features of metabolic syndrome, including type 2 diabetes mellitus (T2DM),” the authors wrote.
“One major complication of T2DM is chronic kidney disease (CKD), for which psoriasis itself is an independent risk factor.
“Current guidelines recommend early initiation of angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs) and/or sodium-glucose cotransporter-2 inhibitors (SGLT2Is) for T2DM patients with microalbuminuria, as these medications reduce albuminuria within months of use and significantly delay CKD progression over several years.
“However, few studies have characterised the risk of CKD in T2DM patients with psoriasis on these medications.”
The US researchers compared outcomes in T2DM patients with and without psoriasis who were prescribed ACEIs, ARBs or SGLT2Is. After adjusting for comorbidities and medications through propensity score matching, researchers observed a persistent increase in renal complications in patients with psoriasis at three-, five- and 10-years post-treatment initiation.
Importantly, even among psoriasis patients receiving biologic therapies such as IL-17, IL-12/23, IL-23 or TNF inhibitors, the risk of CKD remained elevated compared to non-psoriatic controls. This suggests that systemic inflammation characteristic of psoriasis may contribute to renal damage through pathways not mitigated by current CKD treatments.
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“Psoriasis may trigger a T-helper-17-driven inflammatory response, leading to the production of cytokines such as IL-17, IL-12/23 and TNF,” the researchers wrote.
“These cytokines affect renal haemodynamics and stimulate T-lymphocyte infiltration, inducing renal inflammation. This inflammatory response is not targeted by ACEIs, ARBs or SGLT2Is, potentially explaining why T2DM patients with psoriasis on guideline-directed reno-protective medications are still at an increased risk for CKD.
While the study’s reliance on diagnostic coding limits assessment of psoriasis severity and medication adherence, it adds to growing evidence that psoriasis is more than a skin disease—and warrants broader systemic management.
The authors call for prospective trials to further investigate renal outcomes in this high-risk population and explore whether targeted anti-inflammatory strategies could slow CKD progression in patients with comorbid psoriasis and T2DM.
“A prospective study would provide stronger evidence that psoriasis is associated with renal disease, and our study provides preliminary data to potentially power such research,” they concluded.
