Prognostic impact of serum bilirubin level on long-term renal survival in IgA nephropathy
Prognostic impact of serum bilirubin level on long-term renal survival in IgA nephropathy
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DOI：
10.1007/s10157-015-1096-0
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发表时间：
2015-12-01
影响因子：
2.3
通讯作者：
Kitazono, Takanari
中科院分区：
文献类型：
--
作者：
Tanaka, Shigeru;Ninomiya, Toshiharu;Kitazono, Takanari
背景血清胆红素已被认为是一种新型的内源性抗氧化剂。本研究旨在探讨血清胆红素对伊加肾病（IgAN）患者肾脏预后的影响。方法回顾性分析1982年至2010年经肾活检确诊的694例IgAN患者。采用考克斯比例风险模型估计发生终末期肾病（ESRD）的危险因素。通过计算净再分类改善（NRI）和综合辨别改善（IDI），评估模型之间有或没有血清胆红素的预测性能。估计肾小球滤过率、蛋白尿和组织学严重程度与胆红素水平呈负相关。在多变量分析中，血清胆红素是ESRD的独立风险因素（血清胆红素每降低0.1 mg/dL的风险比，1.18; 95% CI，1.04-1.33）。终末期肾病的发生率随胆红素水平的升高而线性下降（P < 0.01）。当胆红素被纳入一个模型与传统的ESRD危险因素，NRI和IDI分别为0.281（P = 0.02）和0.019（P = 0.01），respectively。结论我们表明，较低的胆红素水平与较高的ESRD的危险性IgAN。此外，胆红素在IgAN进展的风险评估中提供了超出标准风险因素的增量预测值。
Background Serum bilirubin has been recognized as a novel endogenous antioxidant. The aim of our study was to evaluate the impact of serum bilirubin on kidney prognosis in IgA nephropathy (IgAN).Methods We followed retrospectively 694 patients with IgAN diagnosed by renal biopsy between 1982 and 2010. The risk factors for developing end-stage renal disease (ESRD) were estimated using a Cox proportional hazard model. Predictive performance between models with or without serum bilirubin was evaluated by calculating the net reclassification improvement (NRI) and integrated discrimination improvement (IDI).Results Seventy-seven patients developed ESRD during the median 4.9 years of follow-up. Estimated glomerular filtration rate, proteinuria and histological severity were inversely related to bilirubin levels. In multivariate analysis, serum bilirubin was an independent risk factor for ESRD (hazard ratio for every 0.1 mg/dL decrease in serum bilirubin, 1.18; 95 % CI, 1.04-1.33). The incidence rate of ESRD decreased linearly with the increases in bilirubin levels (P for trend < 0.01). When bilirubin was incorporated into a model with conventional ESRD risk factors, the NRI and IDI were 0.281 (P = 0.02) and 0.019 (P = 0.01), respectively.Conclusions We demonstrated that lower bilirubin levels were significantly associated with higher risk of ESRD in IgAN. In addition, bilirubin provided incremental predictive value in the risk assessment for progression of IgAN beyond that provided by standard risk factors.