Casual analysis between serum total bilirubin and diabetic nephropathy

XIA Miao; WANG Minzhen; ZHAO Zengyi; XING Yuwei; ZHAO Weili; YANG Hongyan; LIU Zanchao

doi:10.16462/j.cnki.zhjbkz.2023.05.010

Volume 27 Issue 5

May 2023

Turn off MathJax

Article Contents

Article Navigation > CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION > 2023 > 27(5): 551-556

XIA Miao, WANG Minzhen, ZHAO Zengyi, XING Yuwei, ZHAO Weili, YANG Hongyan, LIU Zanchao. Casual analysis between serum total bilirubin and diabetic nephropathy[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2023, 27(5): 551-556. doi: 10.16462/j.cnki.zhjbkz.2023.05.010

Citation:

XIA Miao, WANG Minzhen, ZHAO Zengyi, XING Yuwei, ZHAO Weili, YANG Hongyan, LIU Zanchao. Casual analysis between serum total bilirubin and diabetic nephropathy[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2023, 27(5): 551-556. doi: 10.16462/j.cnki.zhjbkz.2023.05.010

Citation:

PDF( 1438 KB)

Casual analysis between serum total bilirubin and diabetic nephropathy

doi: 10.16462/j.cnki.zhjbkz.2023.05.010

1.
Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China
2.
Hebei Province Key Laboratory of Basic Medicine for Diabetes, Department of Endocrinology, The Second Hospital of Shijiazhuang City, Shijiazhuang 050051, China

Funds:

Key Scientific Research Program of Hebei Health Department Scientific Research Fund Project 20190156

More Information

Corresponding author: WANG Minzhen，E-mail: wangmzhen@lzu.edu.cn; LIU Zanchao, E-mail: liuzanchao2007@163.com
Received Date: 2022-02-07
Rev Recd Date: 2022-06-10
Publish Date: 2023-05-10

Abstract

Abstract

Objective To explore the causal relationship between serum total bilirubin(TBIL) and diabetic nephropathy (DN) using a regression discontinuity design (RDD) approach. Methods We analyzed data from 4 173 participants with type 2 diabetes mellitus (T2DM) at the Second Hospital of Shijiazhuang City. The prevalence of DN was assessed, and significant influencing factors were selected through logistic regression analysis. A risk prediction model was established, and individual DN risk was calculated. RDD was performed using TBIL as the grouping variable and individual DN risk as the outcome variable. Results Of the 4 173 patients with T2DM, 507 had DN (12.15%). The DN risk prediction model identified hyperlipidemia, smoking, drinking, diet control, physical exercise, hypoglycemic drugs, diabetes course, blood urea nitrogen, systolic blood pressure and TBIL as predictive factors. The area under the curve (AUC) for the model was 0.758(95% CI: 0.736-0.779). TBIL was found to be an protective factor for DN(OR=0.967, 95% CI: 0.948-0.987); at TBIL=8 μmol/L, the risk of DN significantly decreased by 5.02%(P=0.004). Conclusions TBIL is a protective factor for DN, and when TBIL=8 μmol/L, the risk of developing DN sharply declines.
- Total bilirubin,
- Diabetic nephropathy,
- Regression discontinuity design,
- Risk prediction

FullText(HTML)

References(32)

References

[1]	Chan JCN, Malik V, Jia WP, et al. Diabetes in Asia: epidemiology, risk factors, and pathophysiology [J]. JAMA, 2009, 301(20): 2129-2140. DOI: 10.1001/jama.2009.726.
[2]	Intemational DF. IDF diabetes atlas-10th edition. [EB/OL]. (2021-12-06) [2022-02-07]. https://blog.csdn.net/wanjiac/article/details/106085105.
[3]	Zhang XX, Kong J, Yun K. Prevalence of diabetic nephropathy among patients with type 2 diabetes mellitus in China: a meta analysis of observational studies [J]. J Diabetes Res, 2020, 2020: 2315607. DOI: 10.1155/2020/2315607.
[4]	Gerstein HC, Mann JF, Yi Q, et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals [J]. JAMA, 2001, 286(4): 421-426. DOI: 10.1001/jama.286.4.421.
[5]	Han SS, Na KY, Chae DW, et al. High serum bilirubin is associated with the reduced risk of diabetes mellitus and diabetic nephropathy [J]. Tohoku J Exp Med, 2010, 221(2): 133-140. DOI: 10.1620/tjem.221.133.
[6]	Targher G, Zoppini G, Cesare Guidi G, et al. Relationship between serum bilirubin and kidney function in non-diabetic and diabetic individuals [J]. Kidney Int, 2009, 75(8): 863. DOI: 10.1038/ki.2008.677.
[7]	Targher G, Bosworth C, Kendrick J, et al. Relationship of serum. bilirubin concentrations to kidney function and albuminuria in the United States adult population. Findings from the national health and nutrition examination survey 2001-2006 [J]. Clin Chem Lab Med, 2009, 47(9): 1055-1062. DOI: 10.1515/CCLM.2009.244.
[8]	Guo ZY, Liu L, Yu FF, et al. The causal association between body mass index and type 2 diabetes mellitus-evidence based on regression discontinuity design [J]. Diabetes Metab Res Rev, 2021, 37(8): e3455. DOI: 10.1002/dmrr.3455.
[9]	Song D, Hurley JC, Lia M. Estimated treatment effects of tight glycaemic targets in mild gestational diabetes mellitus: a multiple cut-off regression discontinuity study design [J]. Int J Environ Res Public Health, 2020, 17(21): 7725. DOI: 10.330/ijer-ph17217725.
[10]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版) [J]. 中华糖尿病杂志, 2021, 13(4): 315-409. DOI: 10.3760/cma.j.cn115791-2021022100095.Chinese Diabetes Society. Guideline for the prevention and treatment of type 2 diabetes mellitus in China(2020 edition) [J]. Chin J Diabetes Mellit, 2021, 13(4): 315-409. DOI: 10.3760/cma.j.cn115791-2021022100095.Chinesecma.j.cn115791-2021022100095.
[11]	中华医学会糖尿病学分会微血管并发症学组. 中国糖尿病肾脏病防治指南(2021年版) [J]. 国际内分泌代谢杂志, 2021, 41(4): 388-410. DOI: 10.3760/cma.j.cn121383-20210825-08064.Microvascular Complications Group of Chinese Diabetes Society. Clinical guideline for the prevention and treat-ment of diabetie kidney disease in China(2021 edition) [J]. Int J Endocrinol Metab, 2021, 41(4): 388-410. DOI: 10.3760/cma.j.cn121383-20210825-08064.
[12]	刘力生. 中国高血压防治指南2010 [J]. 中华高血压杂志, 2011, 19(8): 701-743. DOI: 10.16439/j.cnki.1673-7245.2011.08.009.Liu LS. 2010 Chinese guidelines for the management of hypetension [J]. Chin J Hypertens, 2011, 19(8): 701-743. DOI: 10.16439/j.cnki.1673-7245.2011.08.009.
[13]	诸骏仁, 高润霖, 赵水平, 等. 中国成人血脂异常防治指南(2016年修订版) [J]. 中华全科医师杂志, 2017, 16(1): 15-35. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH201610002.htm Zhu JR, Gao RL, Zhao SP, et al. Guidelines for prevention and treatment of dyslipidenia in Chinese adults (rvised 2016) [J]. Chin J Gen Pract, 2017, 16(1): 15-35. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH201610002.htm
[14]	Chen Q. Advanced econometrics and stata applications (2nd Edi- tion) [M]. Beijing: Higher Education Press, 2014: 10.
[15]	柯箫韵, 翟海龙, 黄飞. 黄石社区2型糖尿病肾病患病率调查及其相关因素研究[J]. 中国全科医学, 2013, 16(12): 1373-1375. DOI: 10.3969/j.issn.1007-9572.2013.04.091.Ke XY, Zhai HL, Huang F. A epidemiological survey on the incidence of type 2 diabetic nephropathy and its related risk factors in Huangshi community [J]. Chin Gen Prac, 2013, 16(12): 1373-1375. DOI: 10.3969/j.issn.1007-9572.2013.04.091.
[16]	郁雨婷, 赵琦, 王娜, 等. 上海市某社区成人2型糖尿病及其合并肾功能不全流行现况及相关因素[J]. 中华疾病控制杂志, 2019, 23(8): 951-955, 976. DOI: 10.16462/j.cnki.zhjbkz.2019.08.013.Yu YT, Zhao Q, Wang N, et al. Epidemiology investigation of type 2 diabetes mellitus and its associated renal insfciency in a community based population in Shanghai [J]. Chin J Dis Control Prev, 2019, 23(8): 951-955, 976. DOI: 10.16462/j.cnki.zhjbkz.2019.08.013.
[17]	胡颖辉, 陈宏, 杨锐, 等. 广东省超重肥胖2型糖尿病患者糖尿病肾病的患病率及危险因素分析[J]. 中国现代医学杂志, 2016, 26(23): 89-94. DOI: 10.3969/j.isn.1005-8982.2016.23.018. Hu YH, Chen H, Yang R, et al. Prevalence and risk factors for diabetic nephropathy in overweight or obese patients with type 2 diabetes mellitus in Guangdong Province [J]. Chin J Mod Med, 2016, 26(23): 89-94. DOI: 10.3969/j.issn.1005-8982.2016.23.018.
[18]	Juutilainen A, Kastarinen H, Antikainen R, et al. Comparison of the MDRD study and the CKD-EPI study equations in evaluating trends of etimated kidney function at population level: findings from the national FINRISK study [J]. Nephrol Dial Transplant, 2012, 27(8): 3210-3217. DOI: 10.1093/ndt/gfs047.
[19]	刘锐, 杨智鹏, 陈磊, 等. 社区2型糖尿病患者并发糖尿病肾病现况及危险因素[J]. 中国老年学杂志, 2019, 39(19): 4679- 4682. DOI: 10.3969/j.issn.1005-9202.2019.19.016. LiuR, Yang ZP, Chen L, et al. Status and risk factors of diabetie nephropathy in conmunity patients with type 2 diabetes mellitus [J]. Chinese Joumal of Gerontology, 2019, 39(19): 4679-4682. DOI: 10.3969/j.issn.1005-9202.2019.19.016.
[20]	Toya K, Babazono T, Hanai K, et al. Association of serum bilirubin levels with development and progression of albuminuria, and decline in estimated glomerular filtration rate in patients with type 2 diabetes mellitus [J]. J Diabetes Investig, 2014, 5(2): 228-235. DOI10.1111/idi. 12134. doi: 10.1111/idi.12134
[21]	Rodella L, Lamon BD, Rezzani R, et al. Carbon monoxide and biliverdin prevent endothelial cell sloughing in rats with type Ⅰ dia betes [J]. Free Radic Biol Med, 2006, 40(12): 2198-2205. DOI: 10.1016/j.freeradbiomed.2006.02.018.
[22]	Boon AC, Bulmer AC, Coombes JS, et al. Circulating bilirubir and defense against kidney disease and cardiovascular mortality: mechanisms contributing to protection in clinical investigations [J]. Am J Physiol Renal Physiol, 2014, 307(2): F123-F136. DOI: 10.1152/aiprenal.00039.2014.
[23]	Hull TD, Agarwal A. Bilirubin: a potential biomarker and therapeutic target for diabetic nephropathy [J]. Diabetes, 2014, 63(8): 2613-2616. DOI: 10.2337/db14-0691.
[24]	Oda E, Aoyagi R, Aizawa Y. Hypobilirubinemia might be a possible risk factor of end-stage kidney disease independently of esti mated glomerular filtration rate [J]. Kidney Blood Press Res, 2012, 36(1): 47-54. DOI: 10.1159/000339027.
[25]	Wu Y, Zhang J, Wang J, et al. The association of serum bilirubin on kidney clinicopathologic features and renal outcome in patients with diabetic nephropathy: a biopsy-based study [J]. Endocr Pract, 2019, 25(6): 554-561. DOI: 10.4158/EP-2018-0560.
[26]	Sakoh T, Nakayama M, Tanaka S, et al. Association of serum total bilirubin with renal outcome in Japanese patients with stages 3-5 chronic kidney disease [J]. Metabolism, 2015, 64(9): 1096-1102. DOI: 10.1016/j.imetabol.2015.06.006.
[27]	Liu M, Li Y, Li J, et al. Elevated serum total bilirubin levels are negatively associated with major diabetic complications among Chinese senile diabetic patients [J]. J Diabetes Complicat, 2017, 31(1): 213-217. DOI: 10.1016/jjdiacomp.2016.08.023.
[28]	Wang J, Li Y, Han X, et al. Association between serum bilirubin levels and decline in estimated glomerular filtration rate among patients with type 2 diabetes [J]. J Diabetes Complicat, 2016, 30(7): 1255-1260. DOI: 10.1016/ijdiacomp.2016.05.013.
[29]	Liu M, Li J, Lyu X, et al. Bilirubin and its changes were negatively associated with diabetic kidney disease incidence and progression: a five year's cohort study based on 5 323 Chinese male diabetic patients [J]. J Diabetes Complicat, 2018, 32(11): 1012-1017. DOI: 10.1016/j.jdiacomp.2018.08.006.
[30]	Okada H, Fukui M, Tanaka M, et al. Low serum bilirubin concentration is a novel risk factor for the development of albuminuria in patients with type 2 diabetes [J]. Metabolism, 2014, 63(3): 409-414. DOI: 10.1016/j.imetabol.2013.11.011.
[31]	Chan WK, Tsai SS, Li YR, et al. Association between serum bilirubin levels and progression of albuminuria in Taiwanese with type 2 diabetes mellitus [J]. Biomed J, 2021, 44(2): 201-208. DOI: 10.1016/j.bi.2019.12.004.
[32]	Tanaka M, FukuiM, Okada H, et al. Low serum bilirubin concentration is a predictor of chronic kidney disease [J]. Atherosclerosis, 2014, 234(2): 421-425. DOI: 10.1016/j.atherosclerosis.2014.03.015.