Abstract
BackgroundRecent studies highlight a negative association between total bilirubin concentrations and albuminuria in patients with type 2 diabetes mellitus. Our study evaluated the relationship between bilirubin concentrations and the prevalence of diabetic nephropathy (DN) in Chinese patients with type 1 diabetes mellitus (T1DM).MethodsA total of 258 patients with T1DM were recruited and bilirubin concentrations were compared between patients with or without diabetic nephropathy. Multiple stepwise regression analysis was used to examine the relationship between bilirubin concentrations and 24 h urinary microalbumin. Binary logistic regression analysis was performed to assess independent risk factors for diabetic nephropathy. Participants were divided into four groups according to the quartile of total bilirubin concentrations (Q1, 0.20–0.60; Q2, 0.60–0.80; Q3, 0.80–1.00; Q4, 1.00–1.90 mg/dL) and the chi-square test was used to compare the prevalence of DN in patients with T1DM.ResultsThe median bilirubin level was 0.56 (interquartile: 0.43–0.68 mg/dL) in the DN group, significantly lower than in the non-DN group (0.70 [interquartile: 0.58–0.89 mg/dL], P < 0.001). Spearman’s correlational analysis showed bilirubin concentrations were inversely correlated with 24 h urinary microalbumin (r = -0.13, P < 0.05) and multiple stepwise regression analysis showed bilirubin concentrations were independently associated with 24 h urinary microalbumin. In logistic regression analysis, bilirubin concentrations were significantly inversely associated with nephropathy. In addition, in stratified analysis, from the first to the fourth quartile group, increased bilirubin concentrations were associated with decreased prevalence of DN from 21.90% to 2.00%.ConclusionHigh bilirubin concentrations are independently and negatively associated with albuminuria and the prevalence of DN in patients with T1DM.
Highlights
Recent studies highlight a negative association between total bilirubin concentrations and albuminuria in patients with type 2 diabetes mellitus
In a recent study that used the deoxycorticosterone acetate (DOCA)-salt model of hypertension in Heine oxygenase (HO)-1-/- and HO-1+/+ mice, systolic arterial pressure was significantly elevated in HO-1-/- mice treated with DOCA salt but not in HO-1+/+ mice; in addition, DOCA-salt impaired vasorelaxation was noted in wild-type rats but not in hyperbilirubinemic rats [6]
Median bilirubin concentrations were 0.56 mg/dL (0.43–0.68 mg/dL) in the diabetic nephropathy (DN) group and 0.70 mg/dL (0.58–0.89 mg/dL) in non-DN patients (P < 0.01), a significant difference. 24 h urinary microalbumin level was significantly higher in the DN group than the non-DN group (196.67 mg vs. 7.01 mg, P < 0.01) and the same trend was observed with the duration of diabetes, systolic blood pressure (SBP), waist-to-hip ratio (WHR), uric acid, creatinine levels (P < 0.01), whereas albumin, haemoglobin, and total Glomerular filtration rate (GFR) levels were lower in the DN group (P < 0.05)
Summary
Recent studies highlight a negative association between total bilirubin concentrations and albuminuria in patients with type 2 diabetes mellitus. In a recent study that used the deoxycorticosterone acetate (DOCA)-salt model of hypertension in Heine oxygenase (HO)-1-/- and HO-1+/+ mice, systolic arterial pressure was significantly elevated in HO-1-/- mice treated with DOCA salt but not in HO-1+/+ mice; in addition, DOCA-salt impaired vasorelaxation was noted in wild-type rats but not in hyperbilirubinemic rats [6]. These results suggest that the HO-1 isozyme and the product bilirubin may have protective effects on vascular disease. In the present study, we evaluated the association between bilirubin concentrations in serum and the prevalence of DN, and we hypothesized that bilirubin concentrations may inversely associate with the prevalence of DN in Chinese patients with T1DM
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