Relationship between serum total bilirubin levels and mortality in uremia patients undergoing long-term hemodialysis

A nationwide cohort study

Hui Hsien Su, Chia Man Kao, Yi Chun Lin, Yen Chung Lin, Chih Chin Kao, Hsi Hsien Chen, Chih Cheng Hsu, Kuan Chou Chen, Chiung Chi Peng, Mai Szu Wu

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3 Citations (Scopus)

Abstract

Background and aims Previous studies show that serum bilirubin has potent antioxidant effect and is associated with protection from kidney damage and reduce cardiovascular events. The aim of this study was to examine the association of serum total bilirubin level and mortality in uremia patients who underwent hemodialysis. Methods This is a nationwide retrospective long-term cohort study. Patients were registered in the Taiwan Renal Registry Data System (TWRDS) from 2005 to 2012. A total of 115,535 hemodialysis patients were surveyed and those with valid baseline total bilirubin (TB) data were enrolled. All-cause mortality was the primary outcome. Results A total of 47,650 hemodialysis patients followed for 27.6 ± 12 months, were divided into 3 groups according to different baseline serum total bilirubin levels (0.1–0.3, 0.3–0.7, 0.7–1.2 mg/dL). Mean age was 61.4 ± 13.6 years, 50% were male, 13% were hepatitis B carriers, and 20% were hepatitis C carriers. Primary outcome was the 3-year mortality. The TB level 0.7–1.2 mg/dL group had high mortality, statistically significant hazard ratio of mortality was 1.14 (crude HR, 95% 1.07–1.20, p < 0.01), and adjusted HR was 1.18 (model 1, 95% CI 1.11–1.25), 1.21 (model 2, 95% CI 1.14–1.29, p < 0.01), 1.44 (model 3, 95% CI 1.06–1.96, p < 0.01), respectively. Sensitivity test showed that after excluding 14,899 patients with hepatitis B or C, or abnormal liver function, the highest level of TB associated with higher significant mortality was still robust. Conclusions In our study, high TB level is associated with mortality in uremia patients undergoing long-term hemodialysis, but further studies of the different effects of unconjugated or conjugated bilirubin on hemodialysis patients are needed.

Original languageEnglish
Pages (from-to)155-161
Number of pages7
JournalAtherosclerosis
Volume265
DOIs
Publication statusPublished - Oct 1 2017

Fingerprint

Uremia
Bilirubin
Renal Dialysis
Cohort Studies
Mortality
Serum
Hepatitis C
Hepatitis B
Kidney
Taiwan
Information Systems
Registries
Antioxidants
Liver

Keywords

  • Atherosclerosis
  • Bilirubin
  • End stage renal disease
  • Hemodialysis
  • Unconjugated

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{ecb7e78ca88a4b3f8c906e27fba1648e,
title = "Relationship between serum total bilirubin levels and mortality in uremia patients undergoing long-term hemodialysis: A nationwide cohort study",
abstract = "Background and aims Previous studies show that serum bilirubin has potent antioxidant effect and is associated with protection from kidney damage and reduce cardiovascular events. The aim of this study was to examine the association of serum total bilirubin level and mortality in uremia patients who underwent hemodialysis. Methods This is a nationwide retrospective long-term cohort study. Patients were registered in the Taiwan Renal Registry Data System (TWRDS) from 2005 to 2012. A total of 115,535 hemodialysis patients were surveyed and those with valid baseline total bilirubin (TB) data were enrolled. All-cause mortality was the primary outcome. Results A total of 47,650 hemodialysis patients followed for 27.6 ± 12 months, were divided into 3 groups according to different baseline serum total bilirubin levels (0.1–0.3, 0.3–0.7, 0.7–1.2 mg/dL). Mean age was 61.4 ± 13.6 years, 50{\%} were male, 13{\%} were hepatitis B carriers, and 20{\%} were hepatitis C carriers. Primary outcome was the 3-year mortality. The TB level 0.7–1.2 mg/dL group had high mortality, statistically significant hazard ratio of mortality was 1.14 (crude HR, 95{\%} 1.07–1.20, p < 0.01), and adjusted HR was 1.18 (model 1, 95{\%} CI 1.11–1.25), 1.21 (model 2, 95{\%} CI 1.14–1.29, p < 0.01), 1.44 (model 3, 95{\%} CI 1.06–1.96, p < 0.01), respectively. Sensitivity test showed that after excluding 14,899 patients with hepatitis B or C, or abnormal liver function, the highest level of TB associated with higher significant mortality was still robust. Conclusions In our study, high TB level is associated with mortality in uremia patients undergoing long-term hemodialysis, but further studies of the different effects of unconjugated or conjugated bilirubin on hemodialysis patients are needed.",
keywords = "Atherosclerosis, Bilirubin, End stage renal disease, Hemodialysis, Unconjugated",
author = "Su, {Hui Hsien} and Kao, {Chia Man} and Lin, {Yi Chun} and Lin, {Yen Chung} and Kao, {Chih Chin} and Chen, {Hsi Hsien} and Hsu, {Chih Cheng} and Chen, {Kuan Chou} and Peng, {Chiung Chi} and Wu, {Mai Szu}",
year = "2017",
month = "10",
day = "1",
doi = "10.1016/j.atherosclerosis.2017.09.001",
language = "English",
volume = "265",
pages = "155--161",
journal = "Atherosclerosis",
issn = "0021-9150",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Relationship between serum total bilirubin levels and mortality in uremia patients undergoing long-term hemodialysis

T2 - A nationwide cohort study

AU - Su, Hui Hsien

AU - Kao, Chia Man

AU - Lin, Yi Chun

AU - Lin, Yen Chung

AU - Kao, Chih Chin

AU - Chen, Hsi Hsien

AU - Hsu, Chih Cheng

AU - Chen, Kuan Chou

AU - Peng, Chiung Chi

AU - Wu, Mai Szu

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Background and aims Previous studies show that serum bilirubin has potent antioxidant effect and is associated with protection from kidney damage and reduce cardiovascular events. The aim of this study was to examine the association of serum total bilirubin level and mortality in uremia patients who underwent hemodialysis. Methods This is a nationwide retrospective long-term cohort study. Patients were registered in the Taiwan Renal Registry Data System (TWRDS) from 2005 to 2012. A total of 115,535 hemodialysis patients were surveyed and those with valid baseline total bilirubin (TB) data were enrolled. All-cause mortality was the primary outcome. Results A total of 47,650 hemodialysis patients followed for 27.6 ± 12 months, were divided into 3 groups according to different baseline serum total bilirubin levels (0.1–0.3, 0.3–0.7, 0.7–1.2 mg/dL). Mean age was 61.4 ± 13.6 years, 50% were male, 13% were hepatitis B carriers, and 20% were hepatitis C carriers. Primary outcome was the 3-year mortality. The TB level 0.7–1.2 mg/dL group had high mortality, statistically significant hazard ratio of mortality was 1.14 (crude HR, 95% 1.07–1.20, p < 0.01), and adjusted HR was 1.18 (model 1, 95% CI 1.11–1.25), 1.21 (model 2, 95% CI 1.14–1.29, p < 0.01), 1.44 (model 3, 95% CI 1.06–1.96, p < 0.01), respectively. Sensitivity test showed that after excluding 14,899 patients with hepatitis B or C, or abnormal liver function, the highest level of TB associated with higher significant mortality was still robust. Conclusions In our study, high TB level is associated with mortality in uremia patients undergoing long-term hemodialysis, but further studies of the different effects of unconjugated or conjugated bilirubin on hemodialysis patients are needed.

AB - Background and aims Previous studies show that serum bilirubin has potent antioxidant effect and is associated with protection from kidney damage and reduce cardiovascular events. The aim of this study was to examine the association of serum total bilirubin level and mortality in uremia patients who underwent hemodialysis. Methods This is a nationwide retrospective long-term cohort study. Patients were registered in the Taiwan Renal Registry Data System (TWRDS) from 2005 to 2012. A total of 115,535 hemodialysis patients were surveyed and those with valid baseline total bilirubin (TB) data were enrolled. All-cause mortality was the primary outcome. Results A total of 47,650 hemodialysis patients followed for 27.6 ± 12 months, were divided into 3 groups according to different baseline serum total bilirubin levels (0.1–0.3, 0.3–0.7, 0.7–1.2 mg/dL). Mean age was 61.4 ± 13.6 years, 50% were male, 13% were hepatitis B carriers, and 20% were hepatitis C carriers. Primary outcome was the 3-year mortality. The TB level 0.7–1.2 mg/dL group had high mortality, statistically significant hazard ratio of mortality was 1.14 (crude HR, 95% 1.07–1.20, p < 0.01), and adjusted HR was 1.18 (model 1, 95% CI 1.11–1.25), 1.21 (model 2, 95% CI 1.14–1.29, p < 0.01), 1.44 (model 3, 95% CI 1.06–1.96, p < 0.01), respectively. Sensitivity test showed that after excluding 14,899 patients with hepatitis B or C, or abnormal liver function, the highest level of TB associated with higher significant mortality was still robust. Conclusions In our study, high TB level is associated with mortality in uremia patients undergoing long-term hemodialysis, but further studies of the different effects of unconjugated or conjugated bilirubin on hemodialysis patients are needed.

KW - Atherosclerosis

KW - Bilirubin

KW - End stage renal disease

KW - Hemodialysis

KW - Unconjugated

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U2 - 10.1016/j.atherosclerosis.2017.09.001

DO - 10.1016/j.atherosclerosis.2017.09.001

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JF - Atherosclerosis

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