Comorbid Psoriasis, NAFLD Linked With Significantly Impaired Kidney Function

Patients with comorbid nonalcoholic fatty liver disease (NAFLD) and chronic plaque psoriasis may be more prone to impaired kidney function and advanced chronic kidney disease (CKD), according to study findings published recently in the Journal of Cutaneous Medicine and Surgery.

As a metabolic disease associated with an increased risk of CKD and other extrahepatic diseases, NAFLD was noted by researchers to have a markedly higher prevalence in patients with psoriasis compared with the general population.

“In addition, patients with psoriatic disease and NAFLD are more likely to suffer from metabolic syndrome, to have a greater severity of psoriasis, and to develop more advanced forms of NAFLD,” they added.

With no studies having investigated the association between NAFLD and impaired renal function in patients with moderate to severe chronic plaque psoriasis, researchers conducted a multicenter, retrospective, observational study of patients who consecutively attended the Dermatology Units of the University Hospitals of Verona and Reggio Calabria between March and October 2020.

In the study, 337 patients with moderate to severe chronic plaque psoriasis (mean [SD] age, 53.7 [13.6] years; 62% men) who had no history of excessive alcohol consumption or other secondary causes of chronic liver and renal diseases were compared based on NAFLD diagnosis, measured by ultrasonography, for CKD or estimated glomerular filtration rate (eGFR) levels.

“CKD stage 2 or greater or stage 3 or greater were defined by an eGFR of less than 90 mL/min/1.73 m² or less than 60 mL/min/1.73 m², respectively.”

Of those examined, 212 patients with moderate to severe chronic plaque psoriasis were diagnosed with NAFLD (mean [SD] age, 57.1 [11.3] years) and 125 were not (mean [SD] age, 47.8 [15.1] years).

Compared with patients not diagnosed with NAFLD, those with NAFLD had significantly lower eGFR levels (93.5 vs 83.4 mL/min/1.73 m²; P < .001) and a notably higher prevalence of both CKD stage 2 or higher (30.4% vs 56.1%; P < .0001) and CKD stage 3 or higher (3.2% vs 10.4%; P < .0001).

Moreover, incidence of impaired renal function remained significantly higher after accounting for components of metabolic syndrome, psoriasis severity, and psoriatic arthritis. Multivariable logistic regression analysis findings showed patients with moderate to severe chronic plaque psoriasis who had NAFLD were 2.6 times more likely to have CKD stage 2 or higher (adjusted odds ratio, 2.60; 95% CI, 1.4-4.8; P = .02).

In concluding, researchers noted several limitations to the study findings, including its cross-sectional design and the use of the creatinine-based equation for estimating eGFR rather than a direct assessment of GFR.

“Conversely, the study has also important strengths, including the large number of participants, the completeness of the dataset and the use of ultrasonography for diagnosing NAFLD.”

Reference

Bellinato F, Goio I, Malara G, et al. Non-alcoholic fatty liver disease is associated with reduced glomerular filtration rate in patients with chronic plaque psoriasis. J Cutan Med Surg. Published online December 12, 2021. doi:10.1177/12034754211066906