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Cao C, Wei S, He L, Li C, Lu Y, Sun W, Wang Y. Temporal alteration of serum bilirubin levels and its renoprotective effects in diabetic kidney disease: exploring the hormonal mechanisms. Front Endocrinol (Lausanne) 2024; 15:1361840. [PMID: 38756998 PMCID: PMC11097656 DOI: 10.3389/fendo.2024.1361840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/18/2024] [Indexed: 05/18/2024] Open
Abstract
Objective This current study represents a novel endeavor to scrutinize the correlation between the temporal alteration in serum total bilirubin (TBIL) concentrations and the rate of estimated glomerular filtration rate (eGFR). Additionally, this study aims to probe the plausible molecular mechanism underpinning the renoprotective effects of bilirubin concerning its hormonal characteristics. Materials and methods In this study, a cohort of 103 patients diagnosed with DKD and receiving medical care at Dongzhimen Hospital were recruited and monitored over a period of 2-7 years. The progression of DKD was ascertained using a threshold of eGFR decline > -5.48%/year. To assess the relationship between the annual change in serum TBIL levels (%/year) and the slope of eGFR, multivariate binary logistic regression analysis was employed. Furthermore, the ROC curve analysis was employed to determine the cut-off value for TBIL levels (%/year). Results The use of multivariate binary logistic regression models revealed that serum TBIL levels (%/year) exhibited a significant correlation with the slope of eGFR. Moreover, the ROC curve analysis indicated a cut-off value of -6.729%/year for TBIL levels (%/year) with a sensitivity of 0.75 and specificity of 0.603, in diagnosing eGFR decline >-5.48%/year. Conclusions The findings of this study suggest that the sustained elevation of serum bilirubin concentration within the physiological range can effectively retard the progression of Diabetic Kidney Disease (DKD). Furthermore, the hormonal attributes of bilirubin may underlie its renoprotective effects.
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Affiliation(s)
- Can Cao
- Department of Nephrology and Endocrinology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Shuwu Wei
- Department of Nephrology and Endocrinology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Leijuan He
- Department of Traditional Chinese Medicine, Dadushe Community Health Service Center, Beijing, China
| | - Chunyao Li
- Department of Nephrology and Endocrinology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yizhen Lu
- Department of Nephrology and Endocrinology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Weiwei Sun
- Department of Nephrology and Endocrinology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yaoxian Wang
- Department of Nephrology and Endocrinology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Xu MR, Jin CH, Lu JX, Li MF, Li LX. High-normal unconjugated bilirubin is associated with decreased risk of chronic kidney disease in type 2 diabetes: A real-world study. Diabetes Metab Res Rev 2023; 39:e3672. [PMID: 37309279 DOI: 10.1002/dmrr.3672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 04/01/2023] [Accepted: 05/26/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate the association between serum unconjugated bilirubin (UCB) within normal limits and chronic kidney disease (CKD) in T2DM patients. METHOD This cross-sectional, real-world study was performed in 8661 hospitalised T2DM patients. The subjects were stratified into quintiles based on serum UCB levels. The clinical characteristics and CKD prevalence were compared among the UCB quantile groups. The associations of serum UCB levels and quintiles with CKD were also analysed by binary logistic regression. RESULTS After controlling for age, sex, and diabetes duration (DD), the CKD prevalence (20.4%, 12.2%, 10.6%, 8.3%, and 6.4% for the first, second, third, fourth, and fifth quintiles, respectively, p < 0.001 for trend) was significantly decreased across the serum UCB quintiles. The fully adjusted regression model showed negative associations of serum UCB levels (OR: 0.660, 95% CI: 0.585-0.744; p < 0.001 for trend) and quintiles (p < 0.001) with the presence of CKD. Compared with the subjects in the lowest UCB quintile, the risk of CKD decreased by 36.2%, 54.3%, 53.8%, and 62.1%, respectively, in those from the second to the highest UCB quintile. Additionally, C-reactive protein (CRP) levels were significantly higher in the subjects with CKD than in those without CKD (p < 0.001), and significantly decreased across the UCB quintiles (p < 0.001 for trend). CONCLUSIONS Serum UCB levels within the normal range were significantly and negatively linked to CKD in T2DM patients. High-normal UCB may be an independent protective factor for CKD by its antioxidant and the following anti-inflammatory activities through its signalling activity, which was indicated by clearly decreased CRP levels across the UCB quintiles.
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Affiliation(s)
- Man-Rong Xu
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
| | - Chun-Hua Jin
- Department of Endocrinology and Metabolism, Shanghai Songjiang District Central Hospital, Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine (Preparatory Stage), Shanghai, China
| | - Jun-Xi Lu
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
| | - Mei-Fang Li
- Department of Emergency, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lian-Xi Li
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
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Panova IG, Tatikolov AS. Endogenous and Exogenous Antioxidants as Agents Preventing the Negative Effects of Contrast Media (Contrast-Induced Nephropathy). Pharmaceuticals (Basel) 2023; 16:1077. [PMID: 37630992 PMCID: PMC10458090 DOI: 10.3390/ph16081077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
The use of conventional contrast media for diagnostic purposes (in particular, Gd-containing and iodinated agents) causes a large number of complications, the most common of which is contrast-induced nephropathy. It has been shown that after exposure to contrast agents, oxidative stress often occurs in patients, especially in people suffering from various diseases. Antioxidants in the human body can diminish the pathological consequences of the use of contrast media by suppressing oxidative stress. This review considers the research studies on the role of antioxidants in preventing the negative consequences of the use of contrast agents in diagnostics (mainly contrast-induced nephropathy) and the clinical trials of different antioxidant drugs against contrast-induced nephropathy. Composite antioxidant/contrast systems as theranostic agents are also considered.
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Affiliation(s)
- Ina G. Panova
- International Scientific and Practical Center of Tissue Proliferation, 29/14 Prechistenka Str., 119034 Moscow, Russia;
| | - Alexander S. Tatikolov
- N.M. Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, 4 Kosygin Str., 119334 Moscow, Russia
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Falode JA, Ajayi OI, Isinkaye TV, Adeoye AO, Ajiboye BO, Brai BIC, ADEOYE, Basiru Olaitan, AJIBOYE, BRAI BIC. Justicia carnea extracts ameliorated hepatocellular damage in streptozotocin-induced type 1 diabetic male rats via decrease in oxidative stress, inflammation and increasing other risk markers. Biomarkers 2023; 28:177-189. [PMID: 36511112 DOI: 10.1080/1354750x.2022.2157487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IntroductionDiabetes mellitus is still a raging disease not fully subdued globally, especially in Africa. Our study aims to evaluate the anti-diabetic potentials of Justicia carnea extracts [crude (JCC), free (JFP) and bound phenol (JBP) fractions], in streptozotocin (STZ)-induced type-1 diabetes in male albino rats.Materials and MethodsAbout thirty (30) animals were induced for type 1 diabetes with STZ; thereafter, treatment began for 14 days, after which the animals were euthanized, blood/serum was collected, the liver was removed and divided into two portions, for biochemical and histopathological analyses. Standard procedures were used to evaluate the liver biomarkers, like alanine transaminase (ALT), fructose-1,6-bisphosphatase, glucose-6- phosphatase, hexokinase activities, albumin, bilirubin, hepatic glucose concentrations; antioxidant status and pro- and anti-inflammatory cytokines were similarly assessed.ResultsThese results revealed that the extracts ameliorated the harmful effects of STZ-induced diabetes in the liver by enhancing the activities of liver-based biomarkers, reducing the concentrations of pro-inflammatory cytokines and increasing the anti-inflammatory cytokine.DiscussionThe results agreed with previous research, and the free phenol fraction showed excellent results compared to othersConclusionThese suggested that J. carnea could serve as an alternative remedy in ameliorating liver complications linked to oxidative damage and inflammation in STZ-induced type-1 diabetes.
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Affiliation(s)
- John Adeolu Falode
- Biomembranes and Molecular Pharmacology and Toxicology Laboratory, Department of Biochemistry, Federal University, Oye-Ekiti, Ekiti State, Nigeria
| | - Oluwaseun Igbekele Ajayi
- Biomembranes and Molecular Pharmacology and Toxicology Laboratory, Department of Biochemistry, Federal University, Oye-Ekiti, Ekiti State, Nigeria
| | - Tolulope Victoria Isinkaye
- Biomembranes and Molecular Pharmacology and Toxicology Laboratory, Department of Biochemistry, Federal University, Oye-Ekiti, Ekiti State, Nigeria
| | - Akinwunmi Oluwaseun Adeoye
- Biomembranes and Molecular Pharmacology and Toxicology Laboratory, Department of Biochemistry, Federal University, Oye-Ekiti, Ekiti State, Nigeria
| | - Basiru Olaitan Ajiboye
- Biomembranes and Molecular Pharmacology and Toxicology Laboratory, Department of Biochemistry, Federal University, Oye-Ekiti, Ekiti State, Nigeria
| | - Bartholomew I C Brai
- Biomembranes and Molecular Pharmacology and Toxicology Laboratory, Department of Biochemistry, Federal University, Oye-Ekiti, Ekiti State, Nigeria
| | - ADEOYE
- Biomembranes and Molecular Pharmacology and Toxicology Laboratory Department of Biochemistry, Federal University, Oye-Ekiti, Ekiti State, Nigeria
| | - Basiru Olaitan
- Biomembranes and Molecular Pharmacology and Toxicology Laboratory Department of Biochemistry, Federal University, Oye-Ekiti, Ekiti State, Nigeria
| | - AJIBOYE
- Biomembranes and Molecular Pharmacology and Toxicology Laboratory Department of Biochemistry, Federal University, Oye-Ekiti, Ekiti State, Nigeria
| | - Bartholomew I. C. BRAI
- Biomembranes and Molecular Pharmacology and Toxicology Laboratory Department of Biochemistry, Federal University, Oye-Ekiti, Ekiti State, Nigeria
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5
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Aoki Y, Cabrera CS, Ouwens M, Bamberg K, Nyström J, Raz I, Scirica BM, Hamrén B, Greasley PJ, Rekić D. Bilirubin levels and kidney function decline: An analysis of clinical trial and real world data. PLoS One 2022; 17:e0269970. [PMID: 35727760 PMCID: PMC9212140 DOI: 10.1371/journal.pone.0269970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate if previously found associations between low serum bilirubin concentration and kidney function decline is independent of hemoglobin and other key confounders. Research design and methods Clinical trial data from the SAVOR-TIMI 53 trial as well as the UK primary care electronic healthcare records, Clinical Practice Research Datalink (CPRD), were used to construct three cohorts of patients at risk of chronic kidney disease (CKD). The randomized clinical trial (RCT) cohort from the subset of SAVOR-TIMI 53 trial consisted of 10,555 type-2 diabetic patients with increased risk of cardiovascular disease. The two observational data cohorts from CPRD consisted of 71,104 newly diagnosed type-2 diabetes (CPRD-DM2) and 82,065 newly diagnosed hypertensive (CPRD-HT) patients without diabetes. Cohorts were stratified according to baseline circulating total bilirubin levels to determine association on the primary end point of a 30% reduction from baseline in estimated glomerular filtration rate (eGFR) and the secondary end point of albuminuria. Results The confounder adjusted hazard ratios of the subpopulation with lower than median bilirubin levels compared to above median bilirubin levels for the primary end point were 1.18 (1.02–1.37), 1.12 (1.05–1.19) and 1.09 (1.01–1.17), for the secondary end point were 1.26 (1.06–1.52), 1.11 (1.01–1.21) and 1.18 (1.01–1.39) for SAVOR-TIMI 53, CPRD-DM2, CPRD-HT, respectively. Conclusion Our findings are consistent across all cohorts and endpoints: lower serum bilirubin levels are associated with a greater kidney function decline independent of hemoglobin and other key confounders. This suggests that increased monitoring of kidney health in patients with lower bilirubin levels may be considered, especially for diabetic patients.
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Affiliation(s)
- Yasunori Aoki
- Clinical Pharmacology and Safety Sciences, AstraZeneca, Gothenburg, Sweden
| | - Claudia S. Cabrera
- Real World Science and Digital, BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Mario Ouwens
- Biometrics Oncology, AstraZeneca, Gothenburg, Sweden
| | - Krister Bamberg
- Early Clinical Development, Research and Early Development, Cardiovascular, Renal, and Metabolism (CVRM) BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Jenny Nyström
- The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Itamar Raz
- Hadassah University Hospital, Jerusalem, Israel
| | - Benjamin M. Scirica
- Brigham and Women’s Hospital Heart & Vascular Center, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Bengt Hamrén
- Clinical Pharmacology and Safety Sciences, AstraZeneca, Gothenburg, Sweden
| | - Peter J. Greasley
- Early Clinical Development, Research and Early Development, Cardiovascular, Renal, and Metabolism (CVRM) BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Dinko Rekić
- Clinical Pharmacology and Safety Sciences, AstraZeneca, Gothenburg, Sweden
- * E-mail:
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Bianco A, Tiribelli C, Bellarosa C. Translational Approach to the Protective Effect of Bilirubin in Diabetic Kidney Disease. Biomedicines 2022; 10:biomedicines10030696. [PMID: 35327498 PMCID: PMC8945513 DOI: 10.3390/biomedicines10030696] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 02/07/2023] Open
Abstract
Bilirubin has been regarded as a powerful endogenous antioxidant and anti-inflammatory molecule, able to act on cellular pathways as a hormone. Diabetic kidney disease (DKD) is a common chronic complication of diabetes, and it is the leading cause of end-stage renal disease. Here, we will review the clinical and molecular features of mild hyperbilirubinemia in DKD. The pathogenesis of DKD involves oxidative stress, inflammation, fibrosis, and apoptosis. Serum bilirubin levels are positively correlated with the levels of the antioxidative enzymes as superoxide dismutase, catalase, and glutathione peroxidase, while it is inversely correlated with C-reactive protein, TNF-α, interleukin (IL)-2, IL-6, and IL-10 release in diabetic kidney disease. Bilirubin downregulates NADPH oxidase, reduces the induction of pro-fibrotic factor HIF-1α expression, cleaved caspase-3, and cleaved PARP induction showing lower DNA fragmentation. Recent experimental and clinical studies have demonstrated its effects in the development and progression of renal diseases, pointing out that only very mild elevations of bilirubin concentrations result in real clinical benefits. Future controlled studies are needed to explore the precise role of bilirubin in the pathogenesis of DKD and to understand if the use of serum bilirubin levels as a marker of progression or therapeutic target in DKD is feasible and realistic.
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Affiliation(s)
- Annalisa Bianco
- Italian Liver Foundation (FIF), 34149 Trieste, Italy; (A.B.); (C.T.)
- National Research Council, Institute of Biomedical Technologies, Bari Unit, 70126 Bari, Italy
| | - Claudio Tiribelli
- Italian Liver Foundation (FIF), 34149 Trieste, Italy; (A.B.); (C.T.)
| | - Cristina Bellarosa
- Italian Liver Foundation (FIF), 34149 Trieste, Italy; (A.B.); (C.T.)
- Correspondence:
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7
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Creeden JF, Gordon DM, Stec DE, Hinds TD. Bilirubin as a metabolic hormone: the physiological relevance of low levels. Am J Physiol Endocrinol Metab 2021; 320:E191-E207. [PMID: 33284088 PMCID: PMC8260361 DOI: 10.1152/ajpendo.00405.2020] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Recent research on bilirubin, a historically well-known waste product of heme catabolism, suggests an entirely new function as a metabolic hormone that drives gene transcription by nuclear receptors. Studies are now revealing that low plasma bilirubin levels, defined as "hypobilirubinemia," are a possible new pathology analogous to the other end of the spectrum of extreme hyperbilirubinemia seen in patients with jaundice and liver dysfunction. Hypobilirubinemia is most commonly seen in patients with metabolic dysfunction, which may lead to cardiovascular complications and possibly stroke. We address the clinical significance of low bilirubin levels. A better understanding of bilirubin's hormonal function may explain why hypobilirubinemia might be deleterious. We present mechanisms by which bilirubin may be protective at mildly elevated levels and research directions that could generate treatment possibilities for patients with hypobilirubinemia, such as targeting of pathways that regulate its production or turnover or the newly designed bilirubin nanoparticles. Our review here calls for a shift in the perspective of an old molecule that could benefit millions of patients with hypobilirubinemia.
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Affiliation(s)
- Justin F Creeden
- Department of Neurosciences, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Darren M Gordon
- Department of Neurosciences, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - David E Stec
- Department of Physiology & Biophysics, Cardiorenal and Metabolic Diseases Research Center, University of Mississippi Medical Center, Jackson, Mississippi
| | - Terry D Hinds
- Department of Pharmacology and Nutritional Sciences, University of Kentucky College of Medicine, Lexington, Kentucky
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8
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Li J, Liu D, Liu Z. Serum Total Bilirubin and Progression of Chronic Kidney Disease and Mortality: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 7:549. [PMID: 33569386 PMCID: PMC7868400 DOI: 10.3389/fmed.2020.00549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 07/31/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Previous studies have suggested that serum total bilirubin (STB) levels are associated with heightened chronic kidney disease (CKD) and mortality in both the general population and nephropathy patients. However, these results remain inconsistent. The aim of our study was to investigate whether STB was a predictor for progression of CKD and mortality by meta-analysis. Methods: We performed a systematic literature search in PubMed, Web of Science, MEDLINE, EMBASE, Google Scholar, and Cochrane Library's database up to June 30, 2019. Pooled risk ratios (RR) and corresponding 95% confidence intervals (CI) were extracted for the highest vs. lowest category STB levels within the physiological range, and a random-effects model was applied to calculate the dose–response relationships. A pooled hazard ratio (HR) was used to investigate the association between STB levels and mortality in dialysis patients. Results: A total of 16 studies, wherein participants were followed from 21 months to 7 years, were eligible for inclusion in the study. For the categorized STB, 11 studies with 41,188 participants were identified and analyzed. Patients with the highest STB levels were associated with a lower risk of CKD (RR = 0.64; 95% CI 0.55–0.73) compared to those with the lowest STB levels. Furthermore, based on seven studies, a pooled RR of 0.89, 95% CI (0.80–0.99) was observed for the continuous STB levels (per 0.2 mg/dL increase). Four studies that included 51,764 participants illustrated that there was no association between STB levels and all-cause mortality (HR = 0.77; 95% CI 0.42–1.41). A prominent negative linear relationship (X2 = 14.70; P = 0.0001) was found between STB levels and risk of CKD. Subgroup analyses showed that there were no significant differences in the subgroup adjustment factor except for sample size. Conclusions: Elevated STB levels within a physiological range are associated with lower risk of CKD regardless of the study characteristics and coincide with a liner dose–response relationship. However, whether high STB levels are a protective factor against mortality remains inconclusive. Large-scale randomized controlled trails are needed to target STB levels for predicting renal outcomes.
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Affiliation(s)
- Jia Li
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Research Institute of Nephrology, Zhengzhou University, Zhengzhou, China.,Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China.,Core Unit of National Clinical Medical Research Center of Kidney Disease, Zhengzhou, China
| | - Dongwei Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Research Institute of Nephrology, Zhengzhou University, Zhengzhou, China.,Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China.,Core Unit of National Clinical Medical Research Center of Kidney Disease, Zhengzhou, China
| | - Zhangsuo Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Research Institute of Nephrology, Zhengzhou University, Zhengzhou, China.,Key Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, China.,Core Unit of National Clinical Medical Research Center of Kidney Disease, Zhengzhou, China
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Chang J, Hou WW, Wang YF, Sun QM. Main Risk Factors Related to Activities of Daily Living in Non-Dialysis Patients with Chronic Kidney Disease Stage 3-5: A Case-Control Study. Clin Interv Aging 2020; 15:609-618. [PMID: 32431494 PMCID: PMC7200239 DOI: 10.2147/cia.s249137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/11/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction Elderly people are at increased risk of falls, disability and death due to reduced functional reserve, decline in multiple systems functions, which affects their activities of daily living (ADL) and eventually develop into frailty. The ADL assessment is conducive to early detection to avoid further serious situations. Previous studies on patients’ activities of daily living with chronic kidney disease (CKD) are mainly focused on dialysis patients. Little information is available on non-dialysis patients. Patients and Methods A total of 303 elderly patients with CKD stage 3–5 who were admitted to our hospital were selected. ADL evaluation was performed on patients at admission, with Barthel index (BI) as the evaluation tool. They were divided into two groups based on BI (≥60 and <60). Demographic information, lifestyle and clinical profile were collected. The risk factors related to ADL were analyzed by univariate and multivariate models. Results The data of 303 patients enrolled in this study were analyzed. The average age of patients was 84.48± 7.14 years and 62.05% were male. There were 88 patients (29.04%) in BI <60 group and 215 patients (70.96%) in the BI ≥60 group. The average age of subjects in the two groups was 87.47 ± 5.85 years and 83.26± 7.28 years, respectively. On univariate analysis, ADL impairment was associated with many factors, such as age, body mass index, blood lipid, heart rate, smoking history, Charlson comorbidity index (CCI), hemoglobin, serum albumin, BNP, eGFR, etc. Multivariate logistic regression showed that age (OR 1.08, 95% CI 1.00–1.17, P=0.0390), Charlson comorbidity index (OR 4.75, 95% CI 1.17–19.30, P=0.0295), and serum albumin (OR 0.80, 95% CI 0.70–0.92, P=0.0012) were the independent risk factors of ADL impairment. Conclusion Decline of ADL in CKD patients was independently correlated with age, Charlson comorbidity index and serum albumin. ADL and its influential factors in the elderly CKD patients deserve further attention.
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Affiliation(s)
- Jing Chang
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Wen-Wen Hou
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yan-Fei Wang
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Qian-Mei Sun
- Department of Internal Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
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10
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Yao Q, Jiang X, Kou L, Samuriwo AT, Xu HL, Zhao YZ. Pharmacological actions and therapeutic potentials of bilirubin in islet transplantation for the treatment of diabetes. Pharmacol Res 2019; 145:104256. [PMID: 31054312 DOI: 10.1016/j.phrs.2019.104256] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/27/2019] [Accepted: 04/30/2019] [Indexed: 12/20/2022]
Abstract
Islet transplantation is the experimental strategy to treat type 1 diabetes by transplanting isolated islets from a donor pancreas into the recipient. While significant progress has been made in the islet transplantation field, islet loss before and after transplantation is still the major obstacle that currently precludes its widespread application. Islet must survive from possible cellular damages during the isolation procedure, storage time, islet injection process and post-transplantation immune rejection, only then the survived islets could produce insulin, actively regulating the blood glucose level. Therefore, islet protection needs to be addressed, especially regarding oxidative stress and immune response induced islet cell damages in diabetic patients. Many clinical data have shown that mildly elevated bilirubin levels in the body negatively correlate to the occurrence of an array of diseases that are related to increased oxidative stress, especially diabetes, and its complications. Recent studies confirmed that bilirubin helps receivers to suppress immune reaction and enable prolonged tolerance to islet transplantation. In this paper, we will review the pharmacological mechanism of bilirubin to modulate oxidative cellular damage and chronic inflammatory reaction in both diabetes and islet transplantation process. Also, we will present the clinical evidence of a strong correlation in bilirubin and diabetes. More importantly, we will summarize undergoing therapeutic applications of bilirubin in islet transplantation and discuss formulation approaches designed to overcome bilirubin delivery issues for future use.
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Affiliation(s)
- Qing Yao
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China.
| | - Xue Jiang
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China
| | - Longfa Kou
- The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Adelaide T Samuriwo
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China
| | - He-Lin Xu
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China
| | - Ying-Zheng Zhao
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou 325035, China.
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11
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Jayanthi R, Srinivasan AR, Maran AL. Clinical sensitivity and specificity of serum total bilirubin - A study on thyroid status in clinically euthyroid non-obese, overweight, and obese type 2 diabetics. Int J Health Sci (Qassim) 2019; 13:22-28. [PMID: 31341452 PMCID: PMC6619454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the sensitivity and specificity of total bilirubin (serum) in determining thyroid status in clinically euthyroid non-obese, overweight, and obese type 2 diabetics. SUBJECTS AND METHODS Three anthropometry specific groups of clinically euthyroid type 2 diabetics were enabled, following enrolment: 153 non-obese (body mass index [BMI] = 18.5-24.99), 291 overweight (BMI = 25-29.99), and 126 obese type 2 diabetes mellitus (BMI ≥30). Total bilirubin (serum), glycemic status, insulin resistance (IR), and thyroid hormones, besides routine biochemistry, were estimated, as per International Federation of Clinical Chemistry approved procedures. RESULTS Receiver operating characteristic curves for non-obese, overweight, and obese were plotted to assess the role of total bilirubin (serum) in determining thyroid status in clinically euthyroid type 2 diabetics. In overweight, the area under curve (AUC) for FT3 and postprandial sugar showed 0.621 and 0.531 with cutoff values of 2.02 pg/ml and 147.5 mg/dl, respectively, whereas for aspartate aminotransferase/alanine aminotransferase (De Ritis ratio), the AUC was 0.583. As regards, obese diabetics and the AUC for insulin and homeostatic model assessment IR were 0.657 and 0.709, respectively, with cutoff values of 16.06 mIU/L and 7.274, respectively, and for postprandial sugar 0.727, in the same group (obese) with cutoff value of 208.5 mg/dl. CONCLUSION Total bilirubin could predict thyroid status and IR in anthropometry specific clinically euthyroid type 2 diabetics.
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Affiliation(s)
- Rajendran Jayanthi
- Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute (A Constituent College of Sri Balaji Vidyapeeth), Pondicherry, India
| | - Abu Raghavan Srinivasan
- Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute (A Constituent College of Sri Balaji Vidyapeeth), Pondicherry, India,Address for correspondence: Dr. Abu Raghavan Srinivasan, Department of Biochemistry, Mahatma Gandhi Medical College and Research Institute (A Constituent College of Sri Balaji Vidyapeeth), Pillaiyarkuppam, Pondy-Cuddalore Main Road, Pondicherry – 607 402, India. Phone: +91-9994455627. Fax.: +91-413-2615457. E-mail:
| | - Anandraj Lokesh Maran
- Department of Community Medicine, Mahatma Gandhi Medical College and Research Institute (A Constituent College of Sri Balaji Vidyapeeth), Pondicherry, India
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Gao Z, Zuo M, Han F, Yuan X, Sun M, Li X, Liu R, Jiang W, Zhang L, Chang B, Yang J. Renal impairment markers in type 2 diabetes patients with different types of hyperuricemia. J Diabetes Investig 2019; 10:118-123. [PMID: 29635733 PMCID: PMC6319488 DOI: 10.1111/jdi.12850] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 01/30/2018] [Accepted: 03/29/2018] [Indexed: 12/26/2022] Open
Abstract
AIMS/INTRODUCTION Hyperuricemia (HUA) occurs because of decreased excretion of uric acid, increased synthesis of uric acid or a combination of both mechanisms. The proportions of these three types of HUA in type 2 diabetes patients are not known. In the mean time, we assume that different types of HUA might manifest with different renal damage, even in patients with normal renal filtration function. MATERIALS AND METHODS We included 435 inpatients with type 2 diabetes at the Metabolic Disease Hospital of Tianjin Medical University from 2015 to 2016. Based on the clearance of uric acid, 90 patients with HUA were divided into three types: synthesis-increased HUA, excretion-decreased HUA and mixed type of HUA. RESULTS Patients with the mixed type of HUA had the severest kidney injury manifested by a high level of 24 h urinary microalbumin, urinary immunoglobulin G, transferrin, α-galactosidase and β2-microglobulin compared with the normal uric acid group. Urinary immunoglobulin G, transferrin and α-galactosidase were also increased in patients with synthesis-increased HUA compared with the normal uric acid group. Patients with excretion-decreased HUA did not have an increased level of renal impairment markers; however, these patients had an increased body mass index, which might cause dysfunction of kidney excretion. CONCLUSIONS Excretion-decreased HUA is a more common type of HUA in type 2 diabetes patients that might be caused by dysfunction of tubular excretion instead of structural damage. The mixed type of HUA patients had the severest kidney glomerular and tubular damage compared with the normal uric acid group. Clinically, different types of hyperuricemia should be given individualized treatment according to their own characteristics.
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Affiliation(s)
- Zhongai Gao
- Key Laboratory of Hormones and Development (Ministry of Health)Tianjin Key Laboratory of Metabolic DiseasesTianjin Metabolic Diseases Hospital & Tianjin Institute of EndocrinologyTianjin Medical UniversityTianjinChina
| | - Minxia Zuo
- Key Laboratory of Hormones and Development (Ministry of Health)Tianjin Key Laboratory of Metabolic DiseasesTianjin Metabolic Diseases Hospital & Tianjin Institute of EndocrinologyTianjin Medical UniversityTianjinChina
| | - Fei Han
- Key Laboratory of Hormones and Development (Ministry of Health)Tianjin Key Laboratory of Metabolic DiseasesTianjin Metabolic Diseases Hospital & Tianjin Institute of EndocrinologyTianjin Medical UniversityTianjinChina
| | - Xinxin Yuan
- Key Laboratory of Hormones and Development (Ministry of Health)Tianjin Key Laboratory of Metabolic DiseasesTianjin Metabolic Diseases Hospital & Tianjin Institute of EndocrinologyTianjin Medical UniversityTianjinChina
| | - Mengdi Sun
- Key Laboratory of Hormones and Development (Ministry of Health)Tianjin Key Laboratory of Metabolic DiseasesTianjin Metabolic Diseases Hospital & Tianjin Institute of EndocrinologyTianjin Medical UniversityTianjinChina
| | - Xiaochen Li
- Key Laboratory of Hormones and Development (Ministry of Health)Tianjin Key Laboratory of Metabolic DiseasesTianjin Metabolic Diseases Hospital & Tianjin Institute of EndocrinologyTianjin Medical UniversityTianjinChina
| | - Ran Liu
- Key Laboratory of Hormones and Development (Ministry of Health)Tianjin Key Laboratory of Metabolic DiseasesTianjin Metabolic Diseases Hospital & Tianjin Institute of EndocrinologyTianjin Medical UniversityTianjinChina
| | - Wenhui Jiang
- Key Laboratory of Hormones and Development (Ministry of Health)Tianjin Key Laboratory of Metabolic DiseasesTianjin Metabolic Diseases Hospital & Tianjin Institute of EndocrinologyTianjin Medical UniversityTianjinChina
| | - Liyi Zhang
- Key Laboratory of Hormones and Development (Ministry of Health)Tianjin Key Laboratory of Metabolic DiseasesTianjin Metabolic Diseases Hospital & Tianjin Institute of EndocrinologyTianjin Medical UniversityTianjinChina
| | - Baocheng Chang
- Key Laboratory of Hormones and Development (Ministry of Health)Tianjin Key Laboratory of Metabolic DiseasesTianjin Metabolic Diseases Hospital & Tianjin Institute of EndocrinologyTianjin Medical UniversityTianjinChina
| | - Juhong Yang
- Key Laboratory of Hormones and Development (Ministry of Health)Tianjin Key Laboratory of Metabolic DiseasesTianjin Metabolic Diseases Hospital & Tianjin Institute of EndocrinologyTianjin Medical UniversityTianjinChina
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Hikasa S, Shimabukuro S, Hideta K, Higasa S, Sawada A, Tokugawa T, Tanaka K, Yanai M, Kimura T. Urinary liver-type fatty acid-binding protein levels as a potential risk factor for renal dysfunction in male HIV-infected Japanese patients receiving antiretroviral therapy: a pilot study. Int J STD AIDS 2018; 29:1424-1431. [PMID: 30114996 DOI: 10.1177/0956462418788432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Renal dysfunction is recognized with increasing frequency among the non-infectious co-morbidities associated with human immunodeficiency virus (HIV) infection. Recently, urinary liver-type fatty acid-binding protein (L-FABP) was suggested to be a predictor of the progression of renal dysfunction in patients without HIV. However, little is known regarding the utility of urinary L-FABP as a predictor of renal dysfunction in patients with HIV. A retrospective, observational, single-centre study was conducted between July 2014 and December 2016. The primary outcome was renal dysfunction defined as decrease in estimated glomerular filtration rate to less than 60 ml/min/1.73 m2. To estimate the effect of urinary L-FABP, proteinuria category, and urinary β2 microglobulin (β2MG) on the time to the first event, a log-rank test was performed. Accuracy, determined by area under the curve and calculated from receiver operating characteristic curves, was also assessed. Thirty Japanese outpatients with HIV receiving antiretroviral therapy (ART) were enrolled. The primary outcome occurred in five patients during the follow-up period. Urinary L-FABP level and proteinuria category were significantly associated with renal dysfunction (p = 0.045 and p = 0.037, respectively). In contrast, urinary β2MG level was not significantly associated with renal dysfunction (p = 0.141). Urinary L-FABP was the most accurate predictor of renal dysfunction among the three urinary parameters. In conclusion, urinary L-FABP levels in HIV patients receiving ART were more accurate for predicting renal dysfunction than proteinuria and urinary β2MG. In addition, urinary L-FABP helped to discriminate those patients with a higher risk for renal dysfunction.
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Affiliation(s)
- Shinichi Hikasa
- 1 Department of Pharmacy, The Hospital of Hyogo College of Medicine, Nishinomiya, Japan
| | - Shota Shimabukuro
- 1 Department of Pharmacy, The Hospital of Hyogo College of Medicine, Nishinomiya, Japan
| | - Kyoko Hideta
- 1 Department of Pharmacy, The Hospital of Hyogo College of Medicine, Nishinomiya, Japan
| | - Satoshi Higasa
- 2 Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Akihiro Sawada
- 2 Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tazuko Tokugawa
- 2 Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kuniyoshi Tanaka
- 1 Department of Pharmacy, The Hospital of Hyogo College of Medicine, Nishinomiya, Japan
| | - Mina Yanai
- 1 Department of Pharmacy, The Hospital of Hyogo College of Medicine, Nishinomiya, Japan
| | - Takeshi Kimura
- 1 Department of Pharmacy, The Hospital of Hyogo College of Medicine, Nishinomiya, Japan
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Li M, Li X, Liu Y, Liu X, Song Y, Zhao J, Mohan C, Wu T, Peng A, Qin L. Relationship between serum bilirubin levels s and the progression of renal function in patients with chronic kidney disease and hyperuricemia. Clin Chim Acta 2018; 486:156-161. [PMID: 30076802 DOI: 10.1016/j.cca.2018.07.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/12/2018] [Accepted: 07/30/2018] [Indexed: 12/11/2022]
Abstract
It is known that inflammation and oxidative stress have strong influences on chronic kidney disease (CKD). As an antioxidant, bilirubin is currently under extensive scrutiny. However, there are disagreements with regard to the oxidative and antioxidative roles of serum uric acid (SUA). This study aimed to investigate the relationship between serum bilirubin and the progression of renal function in CKD patients with hyperuricemia (HUA). This retrospective longitudinal study included 427 CKD patients. The endpoint was renal replacement therapy or death. Patients were divided into the following two groups according to the SUA level: HUA group (SUA ≥ 420 μmol/L for men; SUA ≥ 360 μmol/L for women) and normal uric acid level (NUA) group. A Cox proportional hazards model was used to evaluate the risk factors for renal outcomes in the two patient groups. The median follow-up time was 36 months. In the Cox regression analysis, the risk of renal outcomes in patients with serum indirect bilirubin (IBIL) levels >4.55 μmol/L was 0.15 times the risk in patients with serum IBIL levels ≤4.55 μmol/L (hazard ratio = 0.15, p = .013). Our findings suggest that a high serum IBIL level might be a protective factor for the progression of renal function in CKD patients with HUA.
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Affiliation(s)
- Mengyuan Li
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Xinhua Li
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Yan Liu
- Department of Nephrology, Heze Municipal Hospital, 2888, West Caozhou Road, Shandong 274031, China
| | - Xinying Liu
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Yaxiang Song
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Jian Zhao
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Chandra Mohan
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204-5060, USA
| | - Tianfu Wu
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204-5060, USA
| | - Ai Peng
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China
| | - Ling Qin
- Department of Nephrology & Rheumatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Road, Shanghai 200072, China.
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Uludag K, Oguzhan N, Arıkan T, Boz G. Serum bilirubin level and its impact on the progression of chronic kidney disease. Int Urol Nephrol 2018; 50:1695-1701. [PMID: 29946817 DOI: 10.1007/s11255-018-1923-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 06/20/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE To examine whether an elevated serum total bilirubin level affects the decline in renal function or new-onset chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (DM2). METHODS This was a longitudinal observational study in patients who presented at the University of Health Sciences Hospital in Kayseri. Five hundred twenty-nine patients with DM2 who had conserved renal function were enrolled (estimated glomerular filtration rate > 60 ml/min/1.73 m2). Arising CKD stage 3 was the outcome measure. The patients were separated into three groups based on the total serum bilirubin levels. The first group (G1) ranged from 0.1 to 0.3, the second (G2) 0.4-0.5, and the third (G3) 0.6-0.9 mg/dl. The effect of total serum bilirubin levels on CKD 3 development was assessed using Cox proportional hazards regression. RESULTS The risk of the CKD stage 3 development was highest in G1 who has the lowest serum total bilirubin levels (G1 vs. G3; hazard ratio [HR], 2.02; 95% confidence interval [CI] 1.21-3.36; p = 0.007). In addition, G2 had a significant risk of CKD stage 3 development (G2 vs. G3; hazard ratio [HR], 1.58; 95% confidence interval [CI] 1.08-2.32; p = 0.018). In the adjusted analysis, compared to G2 and G3, G1 had the highest risk (G1 vs. G3; hazard ratio [HR], 2.20; 95% confidence interval [CI] 1.29-3.77; p = 0.004). Similarly, G2 had a higher risk compared to G3 (hazard ratio [HR], 1.57; 95% confidence interval [CI] 1.05-2.34; p = 0.028). CONCLUSIONS Serum bilirubin may predict the progression of CKD in patients with type 2 diabetes and preserved kidney function.
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Affiliation(s)
- Koray Uludag
- Division of Nephrology, Department of Internal Medicine, Health Sciences, University School of Medicine, Training and Research Hospital, Sanayi Mah. Atatürk Bulvarı Hastane Cad. No:78., Kocasinan, 38010, Kayseri, Turkey.
| | - Nilufer Oguzhan
- Nephrology Section, Medicine Service, Atatürk State Hospital, Muratpaşa Mahallesi, Anafartalar Cad., Muratpaşa, 07040, Antalya, Turkey
| | - Tamer Arıkan
- Division of Nephrology, Department of Internal Medicine, Health Sciences, University School of Medicine, Training and Research Hospital, Sanayi Mah. Atatürk Bulvarı Hastane Cad. No:78., Kocasinan, 38010, Kayseri, Turkey
| | - Gulsah Boz
- Division of Nephrology, Department of Internal Medicine, Health Sciences, University School of Medicine, Training and Research Hospital, Sanayi Mah. Atatürk Bulvarı Hastane Cad. No:78., Kocasinan, 38010, Kayseri, Turkey
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