Serum Total Bilirubin and Progression of Chronic Kidney Disease and Mortality: A Systematic Review and Meta-Analysis
Background: Previous studies have suggested that serum total bilirubin (STB) levels are associated with heightened chronic kidney disease (CKD) and mortality in both the general population and nephropathy patients. However, these results remain inconsistent. The aim of our study was to investigate w...
Main Authors: | , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Frontiers Media S.A.
2021-01-01
|
Series: | Frontiers in Medicine |
Subjects: | |
Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2020.00549/full |
id |
doaj-9002255f2cef4b18af077fc4ef55dbb0 |
---|---|
record_format |
Article |
spelling |
doaj-9002255f2cef4b18af077fc4ef55dbb02021-01-25T05:32:30ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-01-01710.3389/fmed.2020.00549539807Serum Total Bilirubin and Progression of Chronic Kidney Disease and Mortality: A Systematic Review and Meta-AnalysisJia Li0Jia Li1Jia Li2Jia Li3Dongwei Liu4Dongwei Liu5Dongwei Liu6Dongwei Liu7Zhangsuo Liu8Zhangsuo Liu9Zhangsuo Liu10Zhangsuo Liu11Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaResearch Institute of Nephrology, Zhengzhou University, Zhengzhou, ChinaKey Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, ChinaCore Unit of National Clinical Medical Research Center of Kidney Disease, Zhengzhou, ChinaDepartment of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaResearch Institute of Nephrology, Zhengzhou University, Zhengzhou, ChinaKey Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, ChinaCore Unit of National Clinical Medical Research Center of Kidney Disease, Zhengzhou, ChinaDepartment of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, ChinaResearch Institute of Nephrology, Zhengzhou University, Zhengzhou, ChinaKey Laboratory of Precision Diagnosis and Treatment for Chronic Kidney Disease in Henan Province, Zhengzhou, ChinaCore Unit of National Clinical Medical Research Center of Kidney Disease, Zhengzhou, ChinaBackground: Previous studies have suggested that serum total bilirubin (STB) levels are associated with heightened chronic kidney disease (CKD) and mortality in both the general population and nephropathy patients. However, these results remain inconsistent. The aim of our study was to investigate whether STB was a predictor for progression of CKD and mortality by meta-analysis.Methods: We performed a systematic literature search in PubMed, Web of Science, MEDLINE, EMBASE, Google Scholar, and Cochrane Library's database up to June 30, 2019. Pooled risk ratios (RR) and corresponding 95% confidence intervals (CI) were extracted for the highest vs. lowest category STB levels within the physiological range, and a random-effects model was applied to calculate the dose–response relationships. A pooled hazard ratio (HR) was used to investigate the association between STB levels and mortality in dialysis patients.Results: A total of 16 studies, wherein participants were followed from 21 months to 7 years, were eligible for inclusion in the study. For the categorized STB, 11 studies with 41,188 participants were identified and analyzed. Patients with the highest STB levels were associated with a lower risk of CKD (RR = 0.64; 95% CI 0.55–0.73) compared to those with the lowest STB levels. Furthermore, based on seven studies, a pooled RR of 0.89, 95% CI (0.80–0.99) was observed for the continuous STB levels (per 0.2 mg/dL increase). Four studies that included 51,764 participants illustrated that there was no association between STB levels and all-cause mortality (HR = 0.77; 95% CI 0.42–1.41). A prominent negative linear relationship (X2 = 14.70; P = 0.0001) was found between STB levels and risk of CKD. Subgroup analyses showed that there were no significant differences in the subgroup adjustment factor except for sample size.Conclusions: Elevated STB levels within a physiological range are associated with lower risk of CKD regardless of the study characteristics and coincide with a liner dose–response relationship. However, whether high STB levels are a protective factor against mortality remains inconclusive. Large-scale randomized controlled trails are needed to target STB levels for predicting renal outcomes.https://www.frontiersin.org/articles/10.3389/fmed.2020.00549/fullserum total bilirubinchronic kidney diseasedisease progressionmortalitymeta-analysis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jia Li Jia Li Jia Li Jia Li Dongwei Liu Dongwei Liu Dongwei Liu Dongwei Liu Zhangsuo Liu Zhangsuo Liu Zhangsuo Liu Zhangsuo Liu |
spellingShingle |
Jia Li Jia Li Jia Li Jia Li Dongwei Liu Dongwei Liu Dongwei Liu Dongwei Liu Zhangsuo Liu Zhangsuo Liu Zhangsuo Liu Zhangsuo Liu Serum Total Bilirubin and Progression of Chronic Kidney Disease and Mortality: A Systematic Review and Meta-Analysis Frontiers in Medicine serum total bilirubin chronic kidney disease disease progression mortality meta-analysis |
author_facet |
Jia Li Jia Li Jia Li Jia Li Dongwei Liu Dongwei Liu Dongwei Liu Dongwei Liu Zhangsuo Liu Zhangsuo Liu Zhangsuo Liu Zhangsuo Liu |
author_sort |
Jia Li |
title |
Serum Total Bilirubin and Progression of Chronic Kidney Disease and Mortality: A Systematic Review and Meta-Analysis |
title_short |
Serum Total Bilirubin and Progression of Chronic Kidney Disease and Mortality: A Systematic Review and Meta-Analysis |
title_full |
Serum Total Bilirubin and Progression of Chronic Kidney Disease and Mortality: A Systematic Review and Meta-Analysis |
title_fullStr |
Serum Total Bilirubin and Progression of Chronic Kidney Disease and Mortality: A Systematic Review and Meta-Analysis |
title_full_unstemmed |
Serum Total Bilirubin and Progression of Chronic Kidney Disease and Mortality: A Systematic Review and Meta-Analysis |
title_sort |
serum total bilirubin and progression of chronic kidney disease and mortality: a systematic review and meta-analysis |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Medicine |
issn |
2296-858X |
publishDate |
2021-01-01 |
description |
Background: Previous studies have suggested that serum total bilirubin (STB) levels are associated with heightened chronic kidney disease (CKD) and mortality in both the general population and nephropathy patients. However, these results remain inconsistent. The aim of our study was to investigate whether STB was a predictor for progression of CKD and mortality by meta-analysis.Methods: We performed a systematic literature search in PubMed, Web of Science, MEDLINE, EMBASE, Google Scholar, and Cochrane Library's database up to June 30, 2019. Pooled risk ratios (RR) and corresponding 95% confidence intervals (CI) were extracted for the highest vs. lowest category STB levels within the physiological range, and a random-effects model was applied to calculate the dose–response relationships. A pooled hazard ratio (HR) was used to investigate the association between STB levels and mortality in dialysis patients.Results: A total of 16 studies, wherein participants were followed from 21 months to 7 years, were eligible for inclusion in the study. For the categorized STB, 11 studies with 41,188 participants were identified and analyzed. Patients with the highest STB levels were associated with a lower risk of CKD (RR = 0.64; 95% CI 0.55–0.73) compared to those with the lowest STB levels. Furthermore, based on seven studies, a pooled RR of 0.89, 95% CI (0.80–0.99) was observed for the continuous STB levels (per 0.2 mg/dL increase). Four studies that included 51,764 participants illustrated that there was no association between STB levels and all-cause mortality (HR = 0.77; 95% CI 0.42–1.41). A prominent negative linear relationship (X2 = 14.70; P = 0.0001) was found between STB levels and risk of CKD. Subgroup analyses showed that there were no significant differences in the subgroup adjustment factor except for sample size.Conclusions: Elevated STB levels within a physiological range are associated with lower risk of CKD regardless of the study characteristics and coincide with a liner dose–response relationship. However, whether high STB levels are a protective factor against mortality remains inconclusive. Large-scale randomized controlled trails are needed to target STB levels for predicting renal outcomes. |
topic |
serum total bilirubin chronic kidney disease disease progression mortality meta-analysis |
url |
https://www.frontiersin.org/articles/10.3389/fmed.2020.00549/full |
work_keys_str_mv |
AT jiali serumtotalbilirubinandprogressionofchronickidneydiseaseandmortalityasystematicreviewandmetaanalysis AT jiali serumtotalbilirubinandprogressionofchronickidneydiseaseandmortalityasystematicreviewandmetaanalysis AT jiali serumtotalbilirubinandprogressionofchronickidneydiseaseandmortalityasystematicreviewandmetaanalysis AT jiali serumtotalbilirubinandprogressionofchronickidneydiseaseandmortalityasystematicreviewandmetaanalysis AT dongweiliu serumtotalbilirubinandprogressionofchronickidneydiseaseandmortalityasystematicreviewandmetaanalysis AT dongweiliu serumtotalbilirubinandprogressionofchronickidneydiseaseandmortalityasystematicreviewandmetaanalysis AT dongweiliu serumtotalbilirubinandprogressionofchronickidneydiseaseandmortalityasystematicreviewandmetaanalysis AT dongweiliu serumtotalbilirubinandprogressionofchronickidneydiseaseandmortalityasystematicreviewandmetaanalysis AT zhangsuoliu serumtotalbilirubinandprogressionofchronickidneydiseaseandmortalityasystematicreviewandmetaanalysis AT zhangsuoliu serumtotalbilirubinandprogressionofchronickidneydiseaseandmortalityasystematicreviewandmetaanalysis AT zhangsuoliu serumtotalbilirubinandprogressionofchronickidneydiseaseandmortalityasystematicreviewandmetaanalysis AT zhangsuoliu serumtotalbilirubinandprogressionofchronickidneydiseaseandmortalityasystematicreviewandmetaanalysis |
_version_ |
1724324610083651584 |