Total Bilirubin in Prognosis for Mortality in End‐Stage Renal Disease Patients on Peritoneal Dialysis Therapy

Abstract

BackgroundEvidence regarding bilirubin's antioxidant properties and predictive roles is growing. However, it is unclear whether serum bilirubin would have a prognostic impact on survival of patients with regular peritoneal dialysis.Methods and ResultsWe used the Taiwan Renal Registry Data System utilizing its 2005‐2012 data set. Data from patients on regular peritoneal dialysis were retrieved. The primary end point of observation was 3‐year mortality. A total of 3704 patients (mean age 53.5 years, 44% male) were enrolled, and these patients were divided according to baseline serum total bilirubin levels (<0.3, 0.3‐0.4, 0.4‐0.5, 0.5‐0.6, >0.6 mg/dL). Serum total bilirubin level was linearly related to age, incidence of hypertension, and type 2 diabetes mellitus. At the end of the observation period with a mean follow‐up of 2.12±1.07 years, 1095 (30.6%) deaths were detected. Serum total bilirubin level and 3‐year mortality rate presented a U‐shaped relationship. Those with serum total bilirubin 0.5 to 0.6 mg/dL had the lowest 3‐year mortality rate (24%). After adjustment for age, sex, underlying systemic disorders, medications, and laboratory discrepancies, serum total bilirubin still played an independent role for predicting 3‐year mortality.ConclusionsBaseline serum total bilirubin level is significantly associated with 3‐year mortality among patients receiving regular peritoneal dialysis.

Relationship between serum bilirubin levels and mortality in patients on peritoneal dialysis

“…In contrast, our study showed that among PD patients, the higher TBil group had a higher mortality risk than that of the lower TBil group, which is consistent with a study by Yang et al. [16], which indicated that PD patients with a high TBil ( > 0.6 mg/dl) had higher all-cause mortality. However, this study did not focus on the associations between the DBil or IBil and the mortality risk of PD patients.…”

“…[28] was Belgian, who cannot represent Asians well. We showed above that the findings of other studies of Asian populations are consistent with ours [14,16]. These factors may have caused the variations between our results and those of others and there are other possible explanations for these different results.…”

“…Thus, there have been conflicting results regarding the effects of bilirubin on CKD and in dialysis patients. In addition, few studies have focused on the effect of bilirubin in PD patients; only one study reported that a slightly elevated TBil level is a protective factor for PD patients and is a useful biomarker for predicting the clinical course of PD patients [16]. However, this study only focused on TBil without distinguishing between direct bilirubin (DBil) and IBil.…”

Baseline liver function tests and full blood count indices and their association with progression of chronic kidney disease and renal outcomes in Aboriginal and Torres Strait Islander people: the eGFR Follow- up Study&nbsp;

“…For the second outcome, de ned as the incidence of a combined renal end point, which was the rst of the following: a 30% decline in eGFR with a follow-up eGFR <60 mL/min/1.73 m 2 , death from renal causes, or initiation of renal replacement therapy, we report an inverse association with concentrations of serum albumin, serum bilirubin and haemoglobin and a positive association with concentrations of GGT and ALP Our study supports the emerging evidence that high bilirubin concentrations may be protective against decline in kidney function and poor renal outcomes. We have previously reported from the eGFR study the inverse association of log-bilirubin with UACR [9].Several other studies suggest a protective role of high serum bilirubin against progression of chronic kidney disease and poor renal outcomes and this may be related to delaying progression of brosis-related kidney disease [18][19][20][21][22][23] In our study of participants with high risk of CKD, there was a statistically signi cant decrease in the baseline concentrations of serum ALT across categories of decreasing eGFR. However, there was no signi cant relationship between baseline concentration of serum ALT and the annual decline in eGFR.…”

Association of Baseline Concentrations of Liver Function Tests and Full Blood Count Indices with Annual eGFR Decline and Renal Outcomes in Aboriginal and Torres Strait Islander People: The eGFR Follow- Up Study

“…against progression of chronic kidney and poor renal outcomes and this may be related to delaying progression of brosis-related kidney disease [18][19][20][21][22][23] In our study of participants with high risk of CKD, there was a statistically signi cant decrease in the baseline concentrations of serum ALT across categories of decreasing eGFR. However, there was no signi cant relationship between baseline concentration of serum ALT and the annual decline in eGFR.…”