Abstract
Chronic kidney disease (CKD) is a major public health problem. However, few studies have examined the significance of serum bilirubin as a risk factor for the development of CKD in the general Japanese population. The subjects comprised 413 men (mean age: 79±9 years; (range, 60–100 years) and 637 women (mean age: 81±8 years; range, 60–106 years) who visited the medical department of Seiyo Municipal Nomura Hospital. We examined the relationship between increased serum bilirubin and renal function that was evaluated by estimated glomerular filtration rate (eGFR) using CKD-EPI equations modified by a Japanese coefficient. Stepwise multiple regression analysis with eGFR as the objective variable, and adjusted risk factors as the explanatory variables, showed that serum bilirubin (β = 0.11, P<0.001) was significantly and independently associated with eGFR, in addition to gender, age, prevalence of antihypertensive medication, triglycerides, prevalence of antidiabetic medication, and serum uric acid. Compared with stages 1+2 (eGFR ≥60.0 ml/min/1.73 m2), mean multivariate-adjusted odds ratio {95% (confidence interval (CI)} for hypobilirubinemia (first quartile, <0.52 mg/dL) was 3.52 (range: 1.88–6.59). Next, to control potential confounding factors, data were further stratified by gender, age, medication (antihypertensive, antidyslipidemic, and antidiabetic agents), and prevalence of cardiovascular disease. The standardized coefficient for eGFR was significant in both groups, and there was no interaction between the groups. Our data demonstrated an independent positive association between serum bilirubin and eGFR in both genders. Low serum bilirubin level would be useful as a potential risk factor for renal function.
Highlights
The increasing prevalence of chronic kidney disease (CKD) is a major public health problem [1]
Targher et al found that serum bilirubin was negatively associated with estimated glomerular filtration rate (eGFR), suggesting that serum bilirubin is a renal risk factor [12]
We have evaluated the relationship between serum bilirubin and potential risk factors such as hypertension, hyperglycemia, and lipids, as well as renal function, using cross-sectional data from elderly persons
Summary
The increasing prevalence of chronic kidney disease (CKD) is a major public health problem [1]. There is convincing evidence that CKD can be detected using simple laboratory tests and is associated with high annual rates of cardiovascular complications and all-cause mortality [2, 3, 4]. A major intravascular product of heme catabolism, has welldocumented neurotoxic effects in infants [5], current evidences demonstrate that mildly elevated serum bilirubin is a potent antioxidant that may provide important protection against inflammation, cardiovascular disease (CVD), and all-cause mortality in adults [6, 7]. Several large studies have shown a positive relationship between serum bilirubin and eGFR [8. 9, 10,11], indicating that serum bilirubin has a potential renoprotective effect. Targher et al found that serum bilirubin was negatively associated with eGFR, suggesting that serum bilirubin is a renal risk factor [12]
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