The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Low serum bilirubin level predicts the development of chronic kidney disease in patients with type 2 diabetes mellitus

  • Ahn, Kang Hee (Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital) ;
  • Kim, Sang Soo (Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital) ;
  • Kim, Won Jin (Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital) ;
  • Kim, Jong Ho (Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital) ;
  • Nam, Yun Jeong (Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital) ;
  • Park, Su Bin (Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital) ;
  • Jeon, Yun Kyung (Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital) ;
  • Kim, Bo Hyun (Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital) ;
  • Kim, In Joo (Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital) ;
  • Kim, Yong Ki (Kim Yong Ki Internal Medicine Clinic)
  • Received : 2015.06.03
  • Accepted : 2016.05.17
  • Published : 2017.09.01
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Abstract

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 ${\geq}60mL/min/1.73m^2$) 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.

Keywords

Acknowledgement

Supported by : Pusan National University Hospital

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