Association between Serum Bilirubin and Estimated Glomerular Filtration Rate among Elderly Persons

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.

Association between Serum Bilirubin and Estimated Glomerular Filtration Rate among Diabetic Patients

“…Lots of studies have shown a positive relationship between serum bilirubin and estimated glomerular filtration rate (eGFR) [ 5 – 9 ], showing that serum bilirubin has a potential renoprotective effect. We also demonstrated an independent positive association between serum bilirubin and eGFR in both genders among elderly persons [ 10 ]. Therefore, it is reasonable to speculate that serum bilirubin levels may be negatively correlated with diabetic nephropathy and renal function among diabetic patients.…”

“…We evaluated the relationship of serum bilirubin with confounding risk factors such as renal function, as well as hypertension, hyperglycemia, and lipids, using cross-sectional data from the Nomura study [ 10 ].…”

Impact of CYP3A5 genotype on tolvaptan pharmacokinetics and their relationships with endogenous markers of CYP3A activity and serum sodium level in heart failure patients

“…A decreased serum level of total bilirubin, which has an antioxidant effect, was a potential risk factor for renal dysfunction. 33,34 Plasma 25-OHD positively correlated with the glomerular filtration rate in patients with chronic kidney disease. 35,36 In our study population, the serum total bilirubin level did not have a significantly positive correlation with the estimated glomerular filtration rate (r s = .226, P = .088) and plasma 25-OHD (r s = .187, P = .160).…”

Associations between serum bilirubin levels and essential trace elements status in an adult population

“…Previous clinical studies have demonstrated that serum bilirubin concentrations are related with chronic obstructive pulmonary disease, migraine and cancer [ 17 – 19 ]. Kawamoto et al [ 20 ] found that serum bilirubin was useful as an underlying risk marker for kidney function. Moreover, a reverse relationship between serum bilirubin and carotid atherosclerosis has been suggested in elderly population [ 21 ], and serum bilirubin concentrations are correlated with disease activity in patients with rheumatoid arthritis and polymyositis [ 22 – 23 ].…”