Psoriasis is a chronic inflammatory disease of the skin and joints that affects about 1–3% of the general population, including 125 million people worldwide.1 It is characterized by well-demarcated, erythematous plaques covered with silvery scales and may significantly impact quality of life depending on the severity. Patients with psoriasis exhibit a greater prevalence of risk factors for cardiovascular disease, such as hypertension, diabetes, obesity, dyslipidemia, atherosclerosis, and smoking.2 The type 1 and type 17 helper T-cell inflammation in psoriasis is central to the pathophysiology of insulin resistance, atherosclerosis, and arterial plaque rupture leading to thrombotic events, as well as cardiovascular disease.1, 2, 3 Studies have suggested that psoriasis is associated with an increased risk of developing severe vascular events such as myocardial infarction (MI) and stroke.1,2 Major risk factors for stroke include diabetes, hypertension, and smoking, which also predispose to cardiovascular risk in general.3

Individuals diagnosed with psoriasis also exhibit an increased risk of developing both chronic kidney disease and end-stage renal disease (ESRD).4,5 The systemic inflammation associated with psoriasis may be the underlying mechanism for the subsequent development of kidney disease. Inflammation may also provide a link between psoriasis and cardiometabolic disorders. On the other hand, impaired kidney function could be due to other comorbidities known to be associated with psoriasis, such as diabetes and hypertension.5 Another possible mechanism proposed is that increased levels of uric acid associated with renal dysfunction may induce tubular injury.4,5

Cardiovascular disease contributes significantly to a reduced 5-year life expectancy that is seen in patients with severe psoriasis.6,7 Even after controlling for various cardiovascular risk factors, patients with psoriasis still show an increased risk of coronary artery disease, stroke, and atherosclerosis.6,7 Psoriasis is undertreated in the general population and even more so in patients with ESRD.8, 9, 10 Based on these considerations, psoriasis may represent an independent risk factor for the development of cardiovascular diseases in the ESRD population. On the other hand, we previously found that when a wide variety of demographic and clinical risk factors were controlled for, ESRD patients with psoriasis showed no increased risk of MI, with confounding attributed to congestive heart failure, pulmonary disease, and diabetes with complications.11 To address whether psoriasis was associated with an increased risk of stroke in the ESRD population, we used the United States Renal Data System (USRDS) database and queried for ESRD patients with psoriasis and stroke, as well as other demographic and clinical risk factors.