Association of serum total bilirubin with renal outcome in Japanese patients with stages 3-5 chronic kidney disease
Association of serum total bilirubin with renal outcome in Japanese patients with stages 3-5 chronic kidney disease
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DOI：
10.1016/j.metabol.2015.06.006
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发表时间：
2015-09-01
影响因子：
9.8
通讯作者：
Kitazono, Takanari
中科院分区：
文献类型：
--
作者：
Sakoh, Teppei;Nakayama, Masaru;Kitazono, Takanari
客观的。据报道，血清胆红素与糖尿病肾病患者肾脏疾病的进展有关。然而，人们对胆红素与其他病因的慢性肾病 (CKD) 之间的关系知之甚少。本研究旨在阐明血清总胆红素浓度是否与 CKD 患者的肾脏疾病进展相关，与病因无关。材料和方法。这项前瞻性观察研究连续招募了 279 名 3-5 期 CKD 患者。肾脏终点是血清肌酐加倍或需要透析的终末期肾病的复合物。根据血清总胆红素浓度将患者分为三组：= 0.6（最高）mg/dL。应用 Cox 比例风险模型来确定肾脏预后不良的危险因素。结果。中位随访期为 21 个月。一百零三名患者达到了肾脏终点。多变量调整后，血清胆红素增加 0.1 mg/dL 与肾脏预后不良呈负相关（风险比 [HA]，0.73；95% 置信区间 [CI]，0.60-0.87）。此外，在调整包括传统和非传统心血管危险因素在内的混杂因素后，中等胆红素组（HR 3.14，95% CI 1.36-8.57）和最低胆红素组（HR 4.22，95% CI 1.81-11.59）的肾脏结局HR显着高于最高胆红素组。结论。较低的血清胆红素浓度与不良肾脏结局独立相关，这表明血清胆红素的测量可用于预测中重度 CKD 患者的肾脏疾病进展。 (C) 2015 Elsevier Inc. 保留所有权利。
Objective. Serum bilirubin has been reported to be associated with the progression of kidney disease in patients with diabetic nephropathy. Less is known, however, about the relationship between bilirubin and chronic kidney disease (CKD) of other etiologies. This study was designed to clarify whether serum total bilirubin concentration is associated with kidney disease progression in patients with CKD independent of etiology.Materials and methods. This prospective observational study enrolled 279 consecutive patients with stages 3-5 CKD. The renal endpoint was the composite of the doubling of serum creatinine or end-stage renal disease requiring dialysis. Patients were divided into three groups by their serum total bilirubin concentrations: = 0.6 (highest) mg/dL. A Cox proportional hazards model was applied to determine the risk factors for poor renal outcome.Results. The median follow-up period was 21 months. One-hundred and three patients reached renal end points. After multivariable adjustment, a 0.1 mg/dL increase in serum bilirubin was associated negatively with poor renal outcome (hazard ratio [HA], 0.73; 95% confidence interval [CI], 0.60-0.87). In addition, after adjustment for confounding factors, including traditional and nontraditional cardiovascular risk factors, the middle (HR 3.14, 95% CI 1.36-8.57) and lowest (HR 4.22, 95% CI 1.81-11.59) bilirubin groups had significantly higher HRs for renal outcome than the highest bilirubin group.Conclusions. Lower serum bilirubin concentration was independently associated with adverse renal outcomes, suggesting that the measurement of serum bilirubin is useful for predicting kidney disease progression in patients with moderate to severe CKD. (C) 2015 Elsevier Inc. All rights reserved.