Association of psoriasis with myocardial infarction in end-stage renal disease patients

Previous research in non-dialysis patients suggests that the inflammatory skin disease psoriasis is associated with an increased risk of severe vascular events like myocardial infarction (MI). Thus, we determined whether psoriasis represents a significant risk factor for MI in end-stage renal disease (ESRD) patients.We queried the United States Renal Data System for ESRD patients starting dialysis between 2004 and 2015. ICD-9 and ICD-10 codes were used to identify those with at least two diagnoses of psoriasis, a diagnosis of MI, and other clinical risk factors. Logistic regression was used to examine the association of psoriasis and various risk factors with MI.Of a cohort of 1,062,693, we identified 6,823 (0.6%) subjects with psoriasis and 181,960 (17.1%) with MI. Of the 6,823 patients with psoriasis, 1,671 (24%) developed an MI. Psoriasis was associated with an increased risk of MI in an unadjusted model [odds ratio (OR)=1.34; confidence interval (CI)=1.26-1.42]. However, after controlling for demographics, dialysis modality, access type, and various conditions related to the Charlson Comorbidity Index, psoriasis was not associated with MI (OR=0.95, CI=0.89-1.01). Confounders of the association of psoriasis with MI included congestive heart failure (OR=5.26, CI=5.17-5.36), pulmonary disease (OR=1.25, CI=1.23-1.26), and diabetes with complications (OR=1.82, CI=1.79-1.85).Contrary to prior research in the general population, in the ESRD population psoriasis was not associated with an increased risk of MI after controlling for various demographic and clinical parameters. These data emphasize the importance of an integrated approach since comorbidities may influence the choice of therapy for psoriasis and outcomes.