Association between serum bilirubin levels and decline in estimated glomerular filtration rate among patients with type 2 diabetes.
AIMS
Studies indicate that elevated serum total bilirubin (TBil) levels are associated with lower risk of diabetic kidney disease (DKD). Few studies examined the associations of direct bilirubin (DBil) and indirect bilirubin (IBil) with the development of DKD.


METHODS
Type 2 diabetes patients (n=2,958) with estimated glomerular filtration (eGFR)≥60mlmin(-1) 1.73m(-2) from the Dongfeng-Tongji cohort were selected and followed up for 5years. Development of DKD was defined as decline in eGFR≥30% during follow-up. Generalize linear model was used to assess the associations of bilirubin levels with DKD development.


RESULTS
Compared with those in the first tertile of serum TBil, the relative risks (RRs) and 95% confidence intervals (CIs) of incident eGFR decline for tertile 2 to 3 were 0.83 (0.64-1.09) and 0.74 (0.56-0.98), Ptrend=0.04. The counterpart RRs (95% CIs) in IBil were 0.74 (0.57-0.97) and 0.75 (0.57-0.98), Ptrend=0.04. No significant associations were observed in DBil. Moreover, TBil and IBil interacted with smoking, the bilirubin-DKD associations were evident in ever smokers.


CONCLUSIONS
Our findings suggest that elevation of serum TBil or IBil levels are independent protective factors for development of DKD, particularly in smokers.
['Wang|Jing|J|', 'Li|Yaru|Y|', 'Han|Xu|X|', 'Hu|Hua|H|', 'Wang|Fei|F|', 'Yu|Caizheng|C|', 'Li|Xiulou|X|', 'Yang|Kun|K|', 'Yuan|Jing|J|', 'Yao|Ping|P|', 'Miao|Xiaoping|X|', 'Wei|Sheng|S|', 'Wang|Youjie|Y|', 'Chen|Weihong|W|', 'Liang|Yuan|Y|', 'Zhang|Xiaomin|X|', 'Guo|Huan|H|', 'Pan|An|A|', 'Yang|Handong|H|', 'Wu|Tangchun|T|', 'He|Meian|M|']
D001663:Bilirubin D015331:Cohort Studies D003924:Diabetes Mellitus, Type 2 D003928:Diabetic Nephropathies D005260:Female D005919:Glomerular Filtration Rate D006801:Humans D008297:Male D008875:Middle Aged D012907:Smoking
Bilirubin Type 2 diabetes Kidney disease Chinese Cohort study