Association of serum bilirubin levels with mortality in patients with diabetes initiating chronic hemodialysis: a competing risks analysis of a single-center cohortReportar como inadecuado




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Renal Replacement Therapy

, 2:52

First Online: 28 October 2016Received: 03 July 2016Accepted: 20 August 2016

Abstract

BackgroundEvidence remains scarce regarding the property of serum bilirubin levels as a prognostic factor for the incidence of mortality in dialysis patients. Here, we aimed to examine the association between serum bilirubin levels and mortality in patients with diabetes initiating hemodialysis.

MethodsThis was a single-center, observational, historical cohort study of 395 Japanese patients with diabetes initiating chronic hemodialysis. There were 98 women and 297 men, and the mean ±SD age was 61 ± 12 years. Patients were dichotomized at the baseline median level of serum bilirubin 0.3 mg-dL. The endpoints were the incidence of all-cause and cause-specific mortality. Hazard ratios for these endpoints were estimated using the Fine-Gray subdistribution hazard model and cause-specific hazard model because of the presence of competing risks.

ResultsDuring a median follow-up period of 3.9 years range; 0.0–10.7 years, there were 83 cases of death, consisting of 39 and 44 cases from atherosclerotic cardiovascular diseases ASCVDs and non-ASCVDs, respectively. In the multivariate competing risks analysis, patients with lower bilirubin levels were associated with higher risk of ASCVD-related mortality subdistribution hazard ratio 3.57, p = 0.015 but not with non-ASCVD-related mortality 0.83, p = 0.665 than those with higher bilirubin levels. Analysis treating bilirubin levels as a continuous variable, as well as cause-specific models yielded the similar results.

ConclusionsLower serum levels of bilirubin may be predictive of higher risk of ASCVD-related mortality in patients with diabetes initiating chronic hemodialysis. There was no relationship between levels of bilirubin and non-ASCVD-related mortality.

KeywordsBilirubin Diabetes mellitus Hemodialysis Mortality Competing risks analysis  Download fulltext PDF



Autor: Kiwako Toya - Tetsuya Babazono - Hidekazu Murata - Ko Hanai - Yasuko Uchigata

Fuente: https://link.springer.com/







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