Kidney Week

Abstract: TH-PO1100

Serum Bilirubin Is a Significant Prognostic Marker for Renal Progression and Mortality in Patients with CKD

Session Information

• CKD: Clinical, Outcomes, Trials - I
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Jung, Young Lee, Seoul National unioversity Hospital, Bucheon, Korea (the Republic of)

Young Lee Jung,

• Kang, Eunjeong, Seoul National University Hospital, Seoul, Korea (the Republic of)

Eunjeong Kang,

• An, Jung Nam, Seoul National University Boramae Medical Center, Seoul, SEOUL, Korea (the Republic of)

Jung Nam An,

• Lim, Chun Soo, Seoul National University Boramae Medical Center, Seoul, SEOUL, Korea (the Republic of)

Chun Soo Lim,

• Oh, Yun Kyu, Department of Internal Medicine, Boramae Medical Center, Seoul, Korea (the Republic of)

Yun Kyu Oh,

• Lee, Jung Pyo, Seoul National University Boramae Medical Center, Seoul, SEOUL, Korea (the Republic of)

Jung Pyo Lee,

Background

Mildly elevated bilirubin could protect kidney damage by reducing oxidative stress. However, it is still unclear that serum bilirubin level can predict clinical outcomes in the patients with CKD. The aim of our study is to investigate the association of serum bilirubin and clinical outcomes in CKD patients.

Methods

A total of 5479 patients who visited nephrology clinic at Seoul National University Boramae Medical Center between 2006 and 2016 were enrolled. Patients were divided 4 groups according to different baseline serum total bilirubin levels. Primary outcome was ESRD and secondary outcome was all-cause mortality. We conducted Cox analysis to evaluate the association between all-cause mortality and ESRD progression. Age, sex, eGFR, hypertension, and diabetes were included as covariates.

Results

Mean serum bilirubin level was 0.7±0.5 mg/dL. A total of 1029patients were a group with the lowest serum bilirubin level (0.5 mg/dL<Bb) and 1723patients had bilirubin level between 0.5mg/dL and 0.7mg/dL.1658patients had bilirubin level between 0.7 g/dL and 1.0mg/dL, 1069 patients with more than 1.0 mg/dL bilirubin. Low bilirubin groups were older and had more hypertension and diabetes. Also, eGFR of low bilirubin groups was lower than that of high bilirubin group. During the follow-up period of 79.4±10.3 months, 412 patients developed ESRD and 691 patients were dead. In the multivariate cox analysis, the higher serum bilirubin level groups had significantly lower risk of ESRD progression, while the group with the lowest mortality rate was not the group with highest bilirubin level but the group with mildly elevated bilirubin(0.7≤Bb<1.0mg/dL) representing reverse J shaped curve.

Conclusion

The lower serum total bilirubin level was significantly related with ESRD progression and mortality. Total serum bilirubin can be used as early biomarker for predicting ESRD development and survival in CKD patients.

Figure 1. Survival curves showing ESRD risk and mortality according to bilirubin levels.