Response to 'Kidney disease in moderate-to-severe psoriasis: a critical appraisal'.
Response to 'Kidney disease in moderate-to-severe psoriasis: a critical appraisal'.
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对“中度至重度银屑病的肾脏疾病：严格评估”的回应。
DOI：
10.1111/bjd.14304
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Gelfand,JM
中科院分区：
文献类型：
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作者：
Wan,J;Gelfand,JM
目的：Wanet等人使用基于人群的队列研究了银屑病患者中至晚期（3-5期）慢性肾脏疾病（CKD）的风险。环境与设计：采用健康改善网络（THIN）数据库构建基于人群的队列。THIN是一个电子初级卫生保健记录数据库，包含常规收集的英国900万名牛皮癣患者的医疗诊断和药物处方数据。数据前瞻性收集了14883名成人（18-90岁）牛皮癣患者。其中，7354人患有严重牛皮癣，根据全身药物的处方代码或光疗的治疗代码来定义。牛皮癣患者与多达5名年龄和实践匹配的非牛皮癣对照。在研究开始前诊断为CKD的患者被排除在外。此外，纳入了来自事件健康结局和牛皮癣事件（iHOPE）研究的基线数据，该研究纳入了8731名25-64岁牛皮癣初级保健患者。银屑病的严重程度根据全科医生估计的体表面积（BSA）累及程度进行分类。使用患者报告的BSA评估工具的类似方法先前在同一组中得到验证。患者按年龄和执业情况与10名非牛皮癣患者对照。研究暴露：银屑病，根据记录的银屑病诊断代码确定。偶发性CKD定义为在随访期间出现与中晚期（3-5期）CKD一致的记录诊断代码或与诊断一致的实验室参数（估计肾小球滤过率< 60 mL min - 11.73 m - 2）。iHOPE研究横截面数据中的流行CKD（如上定义）。结果银屑病整体组、轻度组和重度组CKD发生的校正风险比分别为1.05（95%可信区间为1.02 - 1.07）、0.99 （95% CI为0.97 - 1.02）和1.93 （95% CI为1.79 - 2.08）。在巢式横断面研究（iHOPE）中，轻度、中度和重度牛皮癣组CKD的校正患病率优势比分别为0.89 （95% CI 0.72 - 1.10）、1.36 （95% CI 1.06 - 1.74）和1.58 （95% CI 1.07 - 2.34）。结论：中度至重度牛皮癣与中度至晚期CKD风险增加相关，独立于传统危险因素。
AimUsing a population‐based cohort, Wanet al. examined the risk of moderate‐to‐advanced (stage 3–5) chronic kidney disease (CKD) in patients with psoriasis.Setting and designA population‐based cohort was constructed using The Health Improvement Network (THIN) database. THIN is an electronic primary healthcare records database containing routinely collected medical diagnosis and drug prescribing data on > 9 million patients in the U.K. Data were collected prospectively on 143 883 adults (aged 18–90 years) with psoriasis. Of these, 7354 had severe psoriasis, as defined by prescription codes for systemic medication or treatment codes for phototherapy. Patients with psoriasis were matched with up to five nonpsoriasis age‐ and practice‐matched controls. Patients with a diagnosis of CKD before study entry were excluded. In addition, baseline data from the Incident Health Outcomes and Psoriasis Events (iHOPE) study, a cohort of 8731 primary care patients aged 25–64 years with psoriasis, was included. Psoriasis severity was categorized according to body surface area (BSA) involvement as estimated by general practitioners. A similar method using a patient‐reported BSA assessment tool was previously validated by the same group. Patients were matched by age and practice with 10 nonpsoriasis controls.Study exposurePsoriasis, identified on the basis of a recorded diagnostic code for psoriasis.OutcomesIncident CKD was defined as the presence of a recorded diagnostic code consistent with moderate‐to‐advanced (stage 3–5) CKD or laboratory parameters consistent with the diagnosis (estimated glomerular filtration rate < 60 mL min−11·73 m−2) during follow‐up. Prevalent CKD (as defined above) in the cross‐sectional data from the iHOPE study.ResultsThe adjusted hazard ratios for incident CKD were 1·05 [95% confidence interval (CI) 1·02–1·07], 0·99 (95% CI 0·97–1·02) and 1·93 (95% CI 1·79–2·08) in the overall, mild and severe psoriasis groups, respectively. In the nested cross‐sectional study (iHOPE) the adjusted prevalence odds ratios for CKD were 0·89 (95% CI 0·72–1·10), 1·36 (95% CI 1·06–1·74) and 1·58 (95% CI 1·07–2·34) in the mild, moderate and severe psoriasis groups, respectively.ConclusionsModerate‐to‐severe psoriasis is associated with an increased risk of moderate‐to‐advanced CKD, independently of traditional risk factors.