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KMID : 0338420170320050875
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The Korean Journal of Internal Medicine
2017 Volume.32 No. 5 p.875 ~ p.882
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Low serum bilirubin level predicts the development of chronic kidney disease in patients with type 2 diabetes mellitus
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Ahn Kang-Hee
Kim Sang-Soo
Kim Won-Jin
Kim Jong-Ho
Nam Yun-Jeong
Park Su-Bin
Jeon Yun-Kyung
Kim Bo-Hyun
Kim In-Joo
Kim Yong-Ki
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Abstract
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Background/Aims: We evaluated whether serum bilirubin levels can predict the development of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM).
Methods: This was a retrospective observational longitudinal study of patients presenting at the Pusan National University Hospital. A total of 349 patients with T2DM and preserved kidney function (estimated glomerular filtration rate ≥ 60 mL/min/1.73 m2) were enrolled. The main outcome was the development of CKD stage 3 or greater. The patients were divided into four groups according to the quartiles of the total serum bilirubin levels at baseline.
Results: The group with the lowest range of total serum bilirubin level (Q1) showed the highest cumulative incidence of CKD stage 3 or greater than that of the other lower quartiles (Q1 vs. Q4; hazard ratio [HR], 6.75; 95% confidence interval [CI], 1.54 to 29.47; p = 0.011). In multivariate analysis, the risk of developing CKD stage 3 or greater was higher in the second lowest quartile of the serum bilirubin level than that in the highest quartile of the serum bilirubin level (Q2 vs. Q4; HR, 9.36; 95% CI, 1.33 to 65.73; p = 0.024). In the normoalbuminuria subgroup (n = 236), multivariate analysis showed that the risk of developing CKD stage 3 or greater was higher in the lowest quartile of the serum bilirubin level than that in the highest quartile of the serum bilirubin level (Q1 vs. Q4; HR, 7.36; 95% CI, 1.24 to 35.82; p = 0.019).
Conclusions: Serum bilirubin might be an early clinical marker for predicting the progression of CKD in patients with T2DM and preserved renal function.
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KEYWORD
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Diabetic nephropathies, Bilirubin, Diabetes mellitus, type 2, Renal insufficiency, chronic
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