Su HH, et al. - This study assessed the link between serum total bilirubin (TB) level and mortality in uremia patients who underwent hemodialysis. In uremia patients on long-term hemodialysis, high TB level was found to be associated with mortality.

Methods

• A nationwide retrospective long-term cohort study was performed and patients were registered in the Taiwan Renal Registry Data System (TWRDS) from 2005 to 2012.
• A survey was performed in a total of 115,535 hemodialysis patients and those with valid baseline total bilirubin (TB) data were enrolled.
• All-cause mortality was the primary outcome.

Results

• Data reported that a total of 47,650 hemodialysis patients followed for 27.6 ± 12 months, were divided into 3 different groups according to different baseline serum total bilirubin levels (0.1–0.3, 0.3–0.7, 0.7–1.2 mg/dL).
• It was noted that 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.
• Findings demonstrated that 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.
• Additionally, it was evident in sensitivity test 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.