Psoriasis Is Linked With Higher Risk of Chronic Kidney Disease in Type 2 Diabetes Patients Even With Renoprotective Therapy, Study Finds

First, some cross-disciplinary background: Psoriasis is associated with features of metabolic syndrome and is an independent risk factor for Type 2 diabetes. A major complication of type 2 diabetes is CKD.

People with Type 2 diabetes are routinely tested for microalbuminuria, a condition characterized by slightly but persistently elevated levels of albumin in the urine — too low to be detected with a standard urine dipstick test but a known early indicator of potential kidney damage and also a possible risk factor for cardiovascular disease.

Patients with Type 2 diabetes and microalbuminuria are started early on three types of renoprotective medications: angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), and/or sodium-glucose cotransporter-2 (SGLT2) inhibitors.

All three reduce albuminuria within months of use and significantly delay the progression of CKD over several years. But few studies have examined the risk of CKD among type 2 patients on these drugs who have psoriasis.

Michelle Tarbox, M.D.

Senior author Michelle Tarbox, M.D., an assistant professor at Texas Tech University Health Sciences Center School of Medicine in Lubbock, Texas, and colleagues at Texas Tech and Texas A&M College of Medicine in Dallas conducted a retrospective cohort analysis using TriNetX data to compare the risk of diabetic nephropathy, CKD, end-stage renal disease (ESRD), and dialysis in type 2 diabetes patients with and without psoriasis on each of the three therapies. A total of 7,771 patients with psoriasis also received biologics, including interleukin (IL)-23, IL-17, IL-12/23, or tumor necrosis factor (TNF) alpha inhibitors.

Study findings were published online May 7, 2025, in the Journal of the American Academy of Dermatology as a preprint letter to the editor.

Heightened risk was cleverly evident in the analysis of data, with odds of each outcome — diabetic nephropathy, diabetic chronic kidney disease, end-stage renal disease and dialysis — increasing linearly among patients with psoriasis at three, five and 10 years.

There were no exceptions to that pattern, although the increase in absolute risk was higher for the first two outcomes than the second two. All findings were statistically significant.

Risk also was higher among patients on biologics. Compared with propensity score-matched patients without psoriasis, the authors observed, there was “an increased risk of CKD at 10 years post-index in psoriasis patients using any biologic therapy despite being on accompanying renoprotective therapy.”

The authors speculated that “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,” which induce renal inflammation, and the response is “not targeted by ACEIs, ARBs, or SGLT2is.” That, they continued, may explain the persistently elevated CKD risk in patients with both Type 2 diabetes and psoriasis.

The researchers noted that their results support earlier findings that “biologics do not ameliorate the deterioration of renal function” in patients with existing renal issues, adding that a prospective study would be needed to confirm those associations.