Association of Serum Total Bilirubin and Uric Acid with Low Glomerular Filtration Rate Diabetic Kidney Disease in Type 2 Diabetic Patients

Abstract

Background

Diabetic kidney disease (DKD) is one of the major complications of Type 2 diabetes, clinically characterized by a progressive increase in albuminuria and/or a subsequent decline in glomerular filtration rate. Identification of novel risk factors contributes to reduction in the risk of diabetic kidney disease. Bilirubin, as an antioxidant and anti-inflammatory molecule, is believed to have a protective role in kidney disease. On the other hand, uric acid is implicated in the pathogenesis of DKD due to its pro-oxidant and pro-inflammatory property in vascular tissues.

Methods

A hospital based comparative cross-sectional study was conducted from October 2020 to March 2021 on 200 eligible Type 2 diabetic patients (58 with DKD and 142 without DKD) to assess the association of serum total bilirubin and serum uric acid levels with low GFR diabetic kidney disease using consecutive sampling technique.

Results

The serum total bilirubin level was significantly decreased (0.15±2.29, mean±SD) in the DKD group compared to the non-DKD group (0.19±2.26), whereas the mean±SD serum uric acid was significantly increased in the DKD group (7.13±2.21) compared to the non-DKD group (5.24±1.92). A low serum total bilirubin level was significantly associated with increased risk of DKD in multivariate analysis (AOR=2.23, 95% CI=1.55–4.13) also to high serum uric acid levels (AOR=2.09, 95% CI=1.06–4.12). Moreover, a low serum total bilirubin level was significantly associated with increased risk of DKD among patients with high serum uric acid (AOR=2.55, 95% CI=1.05–6.19). Similarly, high serum uric acid was significantly associated with increased risk of DKD among patients with low serum total bilirubin (AOR=3.49, 95% CI=1.29–9.42).

Conclusion

Co-presence of low serum total bilirubin and high serum uric acid may be useful for stratification of DKD risk among patients with Type 2 diabetes mellitus.

Keywords:

• diabetic kidney disease
• Type 2 diabetes
• serum total bilirubin
• serum uric acid

Data Sharing Statement

Extra data is available on the data repository of Addis Ababa University library.

Ethics Approval and Informed Consent

Ethical approval was obtained from the Institutional Research Review Board of the College of Health Sciences and also from the Research Review Committee of the Department of Biochemistry, Addis Ababa University. Written informed consent was obtained from all participants after a clear briefing of the purpose of the research.

Acknowledgment

Special thanks are extended to Addis Ababa University College of Health Sciences, Department of Biochemistry, Arba Minch University, Ottena teaching and referral hospital, Dr Lukas Dingato, Mr Temesgen Meja, Mr Feyissa Challa, Mr Bedilu, and the study participants.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

The work was supported by the graduate school of Addis Ababa University, Ethiopia.