Relationship between serum bilirubin concentrations and diabetic nephropathy in Shanghai Han’s patients with type 1 diabetes mellitus

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.

Decreased Bilirubin is Associated With Disease Activity of Primary Sjögren's Syndrome

“…[21][22][23][24][25] A number of studies found that bilirubin is a protective factor and decreased in several inflammatory or autoimmune diseases such as atherosclerosis, SLE, RA, PM, and diabetic nephropathy. [14][15][16][17][18][19]26,27 pSS is also a systemic autoimmune disease. It has been suggested that various immune effectors (such as Th1, Th17, T follicular helper, and B cells) may be involved in the pathogenesis of different phases in pSS.…”

Bilirubin Safeguards Cardiorenal and Metabolic Diseases: a Protective Role in Health

“…Although bilirubin signaling was not explicitly evaluated in these studies, UCB treatment was associated with the activation of insulin-signaling pathways and decreased levels of inflammatory cytokines as well as markers of endoplasmic reticulum (ER) stress [10]. Bilirubin has been shown to protect against several complications of diabetes, including diabetic nephropathy and retinopathy [46–48]. While most studies have demonstrated a protective effect of serum bilirubin on the development of type II diabetes and its complications, some studies have reported a detrimental effect of serum bilirubin [49] or reported a U-shaped relationship between serum bilirubin and the development of diabetic retinopathy [50].…”

Association between serum bilirubin and albuminuria in type 2 diabetes mellitus and diabetic nephropathy

“…Other studies conducted in type 1 diabetes patients, also showed negative correlation of total and indirect bilirubin levels with albuminuria. 4,13 Several mechanisms have been proposed to explain the protective role of bilirubin against the development of albuminuria and diabetic nephropathy. 7 Oxidative stress is one of the major mechanisms for the development and progression of diabetic nephropathy.…”