Abstract
A rapid decline in renal function is associated with high cardiovascular morbidity and mortality, and therefore it is important to identify those at high-risk of rapid renal function decline. The relationship between liver function and renal function is unclear. Therefore, in this longitudinal study, we aimed to investigate associations between liver function and rapid renal function decline. A total of 27,116 participants were enrolled from the Taiwan Biobank and followed for 3.8 years. A rapid decline in renal function was defined as a decline in estimated glomerular filtration rate (eGFR) of ≥25%. Binary logistic regression analysis was used to identify associations between liver function parameters (glutamic-oxalacetic transaminase, glutamic-pyruvic transaminase, albumin, α-fetoprotein [AFP], total bilirubin, and gamma-glutamyl transpeptidase) and eGFR decline ≥ 25%. The rate of eGFR decline of ≥25% was 4.7%. Multivariable analysis showed that low albumin (odds ratio [OR], 0.173; p < 0.001), high AFP (OR, 1.006; p = 0.010), and low total bilirubin (OR, 0.588; p < 0.001) were significantly associated with eGFR decline ≥ 25% in all study participants. After excluding abnormal liver function, low albumin (OR, 0.189; p < 0.001), high AFP (OR, 1.007; p = 0.011), and low total bilirubin (OR, 0.569; p = 0.001) were still significantly associated with an eGFR decline of ≥25%. The results of this large population-based cohort study showed associations between low albumin, low bilirubin, and high AFP with a rapid renal function decline. A greater understanding of potential risk factors for a rapid decline in renal function may help to reduce the burden of renal failure in this high-risk population.
Highlights
The incidence and prevalence of end-stage renal disease (ESRD) in Taiwan continue to increase [1], and significantly higher rates of cardiovascular morbidity and mortality have been reported in patients with ESRD compared to the general population [2]
Patients with advanced liver diseases, cirrhosis, and failure have been associated with functional renal impairment, a condition known as hepatorenal syndrome (HRS)
We investigated the associations between liver function parameters and renal function decline among 27,116 participants who were followed for a median of 3.8 years in the Taiwan Biobank (TWB)
Summary
The incidence and prevalence of end-stage renal disease (ESRD) in Taiwan continue to increase [1], and significantly higher rates of cardiovascular morbidity and mortality have been reported in patients with ESRD compared to the general population [2]. A post-hoc analysis of the reduction in endpoints in non-insulin-dependent diabetes mellitus with the Angiotensin II Antagonist Losartan trial and the Irbesartan Diabetic Nephropathy Trial both reported associations between a high bilirubin level and decreased composite renal endpoint of a two-fold increase in serum creatinine or ESRD among patients with diabetic nephropathy. This supports the emerging evidence that high bilirubin may protect against a decline in renal function [11,12]. High bilirubin was associated with better renal outcomes but faster annual decline in renal function in an Australian study [13]
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