Psoriasis and chronic kidney disease: insights into mechanisms and novel therapeutic outlooks.

The pathological association between psoriasis and chronic kidney disease (CKD) has important clinical and mechanistic implications. The two diseases interact through multidimensional mechanisms, yet the underlying regulatory networks and clinical translational potential remain incompletely understood. This review synthesizes epidemiological and mechanistic evidence on the psoriasis-CKD relationship. It focuses on immune pathways-including IL-23/IL-17 axis, T helper 17/regulatory T cell imbalance, and shared immune-related hub genes, such as MX1, DDX58, and ISG20-as well as purine dysmetabolism, oxidative stress, treatment-related nephrotoxicity, and the proposed "dialysis-skin axis." We systematically dissected the association network centered on immune-metabolic crosstalk and explored the underlying mechanisms related to oxidative stress, comorbidity associations, and special populations. The available evidence provides a theoretical framework for developing integrated prevention and treatment strategies targeting psoriasis-related immune-metabolic pathways and offers clinical considerations for patients with advanced kidney disease, those undergoing dialysis, and transplant recipients.