Association of serum bilirubin levels with development and progression of albuminuria, and decline in estimated glomerular filtration rate in patients with type 2 diabetes mellitus.
Association of serum bilirubin levels with development and progression of albuminuria, and decline in estimated glomerular filtration rate in patients with type 2 diabetes mellitus.
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DOI：
10.1111/jdi.12134
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发表时间：
2014-03-23
影响因子：
3.2
通讯作者：
Uchigata Y
中科院分区：
文献类型：
--
作者：
Toya K;Babazono T;Hanai K;Uchigata Y
最近的观察性研究表明，胆红素（一种内源性抗氧化剂）水平升高可能会预防肾脏疾病。我们进行了一项观察性队列研究，以评估在正常范围内较高的基线胆红素水平是否可以预测2型糖尿病患者糖尿病肾病的发生和进展率。从单个中心招募具有正常或微量白蛋白尿和正常血清胆红素（<1.2 mg/dL）的日本2型糖尿病患者，并根据基线血清胆红素水平进行分类。规定了两个独立的终点：糖尿病肾病的发展或进展，基于向更晚期白蛋白尿的转变（白蛋白尿队列），以及估计的肾小球滤过率的变化率（eGFR队列）。分别构建了由1，915例患者和1，898例患者组成的白蛋白尿和eGFR队列，其中1，738例患者重叠。两个队列的平均随访时间分别为4.4年和5.4年。在白蛋白尿队列中，1,418例正常白蛋白尿患者中有132例（9%）出现微量白蛋白尿，497例微量白蛋白尿患者中有56例（11%）出现大量白蛋白尿。在单变量和多变量分析中，较高的基线胆红素水平与从微量白蛋白尿进展为大量白蛋白尿的风险显著降低相关。在正常白蛋白尿患者中，当仅限于血红蛋白A1 c水平升高的亚组时，发现了负相关。胆红素水平与eGFR变化率之间无相关性。在正常范围内，较高的血清胆红素水平可能预示着2型糖尿病患者肾病进展的风险较低。
Recent observational studies suggest elevated levels of bilirubin, an endogenous anti‐oxidant, might protect against kidney disease. We carried out an observational cohort study to assess whether higher baseline levels of bilirubin, within normal range, could predict the rate of development and progression of diabetic nephropathy in patients with type 2 diabetes. Japanese type 2 diabetic patients with normo‐ or microalbuminuria and normal serum bilirubin (<1.2 mg/dL) were recruited from a single center, and categorized according to baseline serum bilirubin levels. Two independent end‐points were specified: development or progression of diabetic nephropathy, based on transition to a more advanced stage of albuminuria (albuminuria cohort), and the rate of change in estimated glomerular filtration rate (eGFR cohort). Albuminuria and eGFR cohorts were constructed consisting of 1,915 patients and 1,898 patients, respectively, with 1,738 patients overlapping. Mean follow up was 4.4 and 5.4 years for the two cohorts, respectively. Within the albuminuria cohort, 132 (9%) of 1,418 patients with normoalbuminuria developed microalbuminuria, and 56 (11%) of 497 patients with microalbuminuria developed macroalbuminuria. Higher baseline bilirubin levels were associated with significantly lower risk of progression from microalbuminuria to macroalbuminuria in both the univariate and multivariate analyses. In normoalbuminuric patients, an inverse association was found when restricted to a subgroup with elevated hemoglobin A1c levels. There was no relationship between bilirubin levels and the rate of change in eGFR. Higher serum bilirubin levels, within normal range, might be predictive of a lower risk of progression of nephropathy in type 2 diabetic patients.
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影响因子：
4.8
作者：
Gorin, Y;Block, K;Abboud, HE
通讯作者：
Abboud, HE
DOI：
10.1152/ajprenal.00215.2004
发表时间：
2005-04-01
影响因子：
4.2
作者：
Adin, CA;Croker, BP;Agarwal, A
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Agarwal, A
DOI：
10.1152/ajprenal.00221.2004
发表时间：
2005-06-01
影响因子：
4.2
作者：
Satoh, M;Fujimoto, S;Kashihara, N
通讯作者：
Kashihara, N
影响因子：
13.2
作者：
Matsuo, Seiichi;Imai, Enyu;Hishida, Akira
通讯作者：
Hishida, Akira
影响因子：
15.9
作者：
Niwa, T;Katsuzaki, T;Takei, Y
通讯作者：
Takei, Y