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Abstract: SA-PO236

Association Between Serum Total Bilirubin Levels and Mortality in Dialysis Patients

Session Information

Category: Anemia and Iron Metabolism

  • 202 Anemia and Iron Metabolism: Clinical

Authors

  • Miyagi, Tsuyoshi, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Kimura, Hiroshi, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Tantisattamo, Ekamol, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Rhee, Connie, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Kalantar-Zadeh, Kamyar, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
Background

Serum bilirubin may have a potent antioxidant effect and may be associated with protection from cardiovascular disease (CVD) in non-dialysis patients. It is unknown if serum bilirubin levels (sTB) can predict subsequent mortality risk following dialysis initiation in patients at high risk of developing CVD.

Methods

We identified 3,769 patients who transitioned to maintenance dialysis in a large US dialysis organization (2007-2011) and had available sTB data at baseline. Patients with abnormally high (>1.3 mg/dL) and low (<0.1 mg/dL) sTB or liver disease were excluded from the cohort. We divided patients into 12 groups based on their sTB levels (0.1-<0.3 [ref.], 0.3-<0.4, 0.4-<0.5, 0.5-<0.6, 0.6-<0.7, 0.7-<1.3 mg/dL) and age (<65 years, ≥65 years). All-cause mortality risk was examined using Cox models with adjustment for case-mix (age, gender, race/ethnicity, hypertension, diabetes and CVD) and a fully adjusted model (case-mix model plus body mass index and 11 laboratory variables).

Results

The mean age was 62 ± 15 (mean ± SD) years, 56% of patients were male, and 48% were non-white. There were significant differences in all clinically relevant factors used for adjusted models among the non-elderly and elderly groups. In both the non-elderly and elderly patient groups, those with high sTB levels had the highest hazard ratio (HR) after full adjustment vs. the 0.1-<0.3 mg/dL group (HRs:1.68 [95% CI, 1.13-2.50] and 1.93 [95% CI, 1.41-2.64], respectively). [figure]

Conclusion

In contrast to conventional studies, higher sTB levels within normal ranges are associated with higher mortality in incident dialysis patients. Aging and uremia under dialysis might attenuate an antioxidant effect of bilirubin. Whether bilirubin can be used as an independent risk factor for mortality in dialysis patients warrants additional studies.

Funding

  • NIDDK Support