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Today, I’m going to provide more information on something I am experiencing, Viral Warts. Tomorrow I have a real go-around with my new dermatologist, where we should start to have some of the numerous cancers on and around my head treated. If I’m still alive (grin), I will relate the experience. Friday, I have, IMHO, a really great Financial Friday in mind for you. As in the past, it will be based on my actual investment activity, how I decided what to invest in, and what the investment’s future may yield. Wednesday and Thursday are open at this point, and on Sunday, when I’m writing this blog. I just picked up on the Grammarly AI writing assistant with Black Friday half-price deal, so standby.

During last week’s meeting with my dialysis team, we (my wife and I) brought up the subject of Viral Warts and didn’t get anywhere or any satisfaction. We don’t know if they had not encountered them previously or if it was just a lack of empathy. At times, they can be stoic at best, probably hardened by their experiences, which is understandable to a degree.

So, aside from being diagnosed with this new affliction, I wanted to know more about the population of dialysis patients “blessed” with viral warts. I turned to Perplexity.ai with the following prompt and results. Along the way in researching this topic, I learned that I fit just about all of the If then -> warts criteria: age, sex, time on dialysis, etc.

Prompt: What are the characteristics of ESRD patients who develop renal warts?

Most descriptions of “who gets warts” in kidney disease are about transplant recipients, so the data for ESRD itself are thinner; however, a pattern emerges from dialysis and CKD skin‑series and from HPV‑cancer data. In ESRD, warts seem to occur in patients who share the general ESRD risk profile (uremic immune dysfunction, long disease duration) plus the usual HPV risk factors seen in the general population.pmc.ncbi.nlm.nih+3​

Demographic tendencies

  • Middle‑aged and older adults: HPV‑related cancers in ESRD peak around ages 50–64, implying that persistent HPV infection (and thus warts) is most relevant in this age band.pmc.ncbi.nlm.nih​
  • Both sexes are affected, with some signals by sex: For HPV‑related cancers in ESRD, female sex is a risk factor (IRR ≈ 2.1 vs ESRD men). For cutaneous warts specifically, one CKD skin‑disease review notes common warts among ESRD patients without a strong sex skew. Still, detailed sex‑stratified wart data are rarely reported.pmc.ncbi.nlm.nih+2​

Renal and dialysis‑related characteristics

  • Advanced, long‑standing renal failure: Reviews of cutaneous disease in CKD/ESRD emphasize that viral infections including common warts are a recognized problem mainly in patients with advanced uremia and on long‑term renal replacement therapy.actasdermo+1​
  • Dialysis, any modality: Hemodialysis cohorts show low but definite wart prevalence (a few percent in series of 100–200 patients), and authors note that “human papillomavirus–induced warts are common in kidney disease,” reflecting the background uremic immune defect rather than a specific dialysis type. Peritoneal dialysis appears similar or slightly less studied rather than clearly different.pmc.ncbi.nlm.nih+1​
  • Heavy comorbidity burden: ESRD patients with higher overall comorbidity have more infection‑related complications in general. However, for HPV‑related cancers specifically, comorbidity level was not a clear additional risk factor once ESRD status itself was accounted for.karger+1​

Immune and virologic factors

  • Uremic immune dysfunction: Reviews of skin disease in CKD highlight that ESRD patients have impaired cellular immunity, altered T‑cell and antigen‑presenting cell function, and chronic inflammation, which collectively predispose to chronic viral skin infections such as warts.actasdermo+2​
  • Difficulty clearing HPV: The same immune defects that raise cancer risk also make HPV infections more persistent, which is why ESRD cohorts show a 2–2.5‑fold higher incidence of HPV‑related cancers compared with the general population. Persistent high‑risk HPV infection is biologically linked to both genital warts (from certain types) and HPV‑related dysplasia and cancer.frontiersin+1​
  • General HPV risk factors still matter: Systematic reviews of cutaneous warts (in mixed populations) note that smoking, close personal contact, communal environments, and atopy increase wart risk. For HPV‑associated cancers (which track high‑risk HPV exposure), smoking, alcohol, and HIV infection are important cofactors. These same factors likely identify the subgroup of ESRD patients more prone to clinically evident or persistent warts.onlinelibrary.wiley+2​

Clinical wart pattern in ESRD

  • Low absolute prevalence, but higher than normal: Skin‑series in hemodialysis show warts in only a few percent of patients, yet this is still more frequent than in matched healthy controls, and authors explicitly list viral warts among the “most frequent viral infections” in CKD skin disease.healthcare-bulletin+2​
  • Stubborn, chronic lesions: When warts appear in ESRD, clinicians describe them as more persistent and sometimes refractory, mirroring the broader experience of infections in ESRD patients.pmc.ncbi.nlm.nih+1​
  • Association with other skin problems of CKD: Patients with xerosis, pruritus, pigment changes, and other CKD skin abnormalities are the same broad group in which warts are reported; warts are one item in this constellation rather than a distinct phenotype.ijdvl+2​

Putting this together for “who gets warts” in ESRD

ESRD patients who develop warts typically have:

  • Long‑standing, advanced renal failure on dialysis with uremic immune dysfunction.actasdermo+1​
  • Usual HPV exposure/risk factors (sexual exposure, close skin contact, sometimes smoking or other co‑morbid risks).pubmed.ncbi.nlm.nih+2​
  • Age in mid‑ to later adulthood, where persistent HPV infection and HPV‑related disease are most evident.pmc.ncbi.nlm.nih​

Unlike the transplant setting, there is no sharply defined “wart phenotype” (for example, specific drugs), but rather a background of modest immune fragility in ESRD that makes the usual HPV exposures more likely to result in chronic, slow‑to‑clear warts.

  1. https://pmc.ncbi.nlm.nih.gov/articles/PMC3710213/
  2. https://onlinelibrary.wiley.com/doi/10.1111/pde.16002
  3. https://pmc.ncbi.nlm.nih.gov/articles/PMC8061480/
  4. http://www.actasdermo.org/en-skin-manifestations-chronic-kidney-disease-articulo-S0001731015002720
  5. https://pmc.ncbi.nlm.nih.gov/articles/PMC4299702/
  6. https://karger.com/bpu/article/47/1-3/259/329355/Recognizing-Common-Skin-and-Soft-Tissue-Infections
  7. https://www.actasdermo.org/en-skin-manifestations-chronic-kidney-disease-articulo-S1578219015002346
  8. https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2022.1057454/full
  9. https://pubmed.ncbi.nlm.nih.gov/32503931/
  10. https://journals.sagepub.com/doi/abs/10.1136/jim-2019-001262
  11. https://www.healthcare-bulletin.co.uk/article/volume-14-issue-3-pages870-878-ra/
  12. https://ijdvl.com/cutaneous-manifestations-in-patients-with-chronic-renal-failure-on-hemodialysis/
  13. https://www.ijord.com/index.php/ijord/article/view/1234
  14. https://www.sciencedirect.com/science/article/pii/S1600613522089079
  15. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2772021
  16. https://emedicine.medscape.com/article/1094846-overview
  17. https://www.semanticscholar.org/paper/Incidence-and-risk-factors-for-HPV-associated-in-Han-Waller/fe6a798835199fa86e050e34bcdb696514e80486
  18. https://onlinelibrary.wiley.com/doi/10.1111/ajt.14181
  19. https://nigjdermatology.com/index.php/NJD/article/download/31/6/121
  20. https://www.ectrx.org/detail/archive/2019/17/1/0/31/0
  21. https://academic.oup.com/ndt/article/32/1/132/2931147