The risk of skin infections in end-stage renal disease patients with porphyria cutanea tarda: A retrospective cohort study

Background: Porphyria cutanea tarda (PCT) is one of many conditions characterized by increased photosensitivity, manifesting as blistering lesions on sun-exposed skin. Due to the increased photosensitivity and skin fragility, PCT patients are more susceptible to infections. Individuals with end-stage renal disease (ESRD), a potential complication of PCT, also exhibit an increased risk of infection. Due to these combined risks, this retrospective cohort study sought to determine if PCT is an independent risk factor for certain infections in the ESRD population. Methods: This study examined dialysis recipients within the United States Renal Data System database from 2005 to 2019. A diagnosis of PCT was determined using International Classification of Disease (ICD)-9 and ICD-10 codes and identified 1,019 (0.07 %) out of a total of 1,398,765 ESRD patients who met the inclusion and exclusion criteria. Bacterial infections, cellulitis, blisters, abscesses, and bacteremia were queried as outcomes. Logistic regression analysis determined the impact of PCT on the risk of each infection after controlling for demographic and clinical factors. Results: PCT was associated with a significantly decreased risk for 3 out of the 5 outcomes: bacterial infections (adjusted odds ratio: 0.50; 95 % confidence interval: 0.43–0.58), cellulitis (0.61; 0.53–0.71), and bacteremia (0.44; 0.38–0.52). No significant positive or negative association was found between PCT and blisters or abscesses. Conclusions: These results indicate that ESRD patients with PCT are actually at decreased risk of some infections compared with ESRD patients without comorbid disease. The reason is unclear but could be related to either the disease process or its clinical management.