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Abstract SUMMARY Cardiovascular diseases are the leading cause of mortality and morbidity in patients with Type2 diabetes (Isomaa et al., 2001) especially in hemodialysis patients (Parfrey and Foley, 1999). Previous studies have reported that low serum bilirubin concentrations are associated with an increased risk of cardiovascular disease (Schwertner et al., 1994, Breimer et al., 1995). The aim of the study was to assess the value of measurement of serum bilirubin concentration in type2 diabetes mellitus patients on maintenance hemodialysis and to confirm its association with cardiovascular complication. The study was carried on 45 patients of type2 diabetes mellitus who were randomly selected from the department and outpatient clinic of Internal Medicine and Nephrology, [Damanhur Medical National Institute]. These patients were divided into 2 groups: Group A containing 25 diabetic Patients receiving maintenance hemodialysis three times per week and Group B containing 20 diabetic Patients do not receive maintenance hemodialysis. All the included individuals were subjected to detailed History taking and thorough clinical examination (with special emphasis on age; sex; habit of smoking; blood pressure; duration of diabetes; and presence of cardiovascular disease), calculation of BMI, Echocardiography and brain computed tomography, when needed. Laboratory investigations were 202 carried on including: Serum total cholesterol, Glycemic control (which is monitored by HBA1c, in non hemodialysis group, and Glycated Albumin, in hemodialysis group), Serum total bilirubin and Serum indirect bilirubin. In our work, CVD events were associated with hemodialysis as reflected by significantly higher number and percentage of CVD in group A and significant difference between diabetics with and without CVD in being on hemodialysis (p<0.05). 40% (18 patients) of our patients had CVD, 56% (14 patients) of group A patients vs. 20% (4 patients) of group B patients with statistically significant difference (p=0.018). Also, 14 (77.8%) of the patients who had CVD where on HD vs. 11(40.7%) of the patients who didn’t have CVD were on HD, which was a significant difference (p=0.018). We found that serum total bilirubin level (0.66+ 0.1 mg/dl vs. 0.84+0.2 mg/dl, p=0.001) and serum indirect bilirubin level (0.52+ 0.13 mg/dl vs. 0.67+.15, p=0.001) were significantly lower in patients with CVD. Both Serum total and indirect bilirubin were negatively associated with CVD (p= 0.001). These findings indicated the association between higher serum total and indirect bilirubin in patients without CVD and consequently its protective effect. Presence of hemodialysis was negatively correlated with serum indirect bilirubin (p=0.032). We found that serum indirect bilirubin level (0.56+ 0.1 mg/dl vs. 0.67+ 0.1 mg/dl, p=0.029) was significantly lower in group A, however, although serum total bilirubin level was lower in group A, the difference was statistically insignificant (0.73+ 0.17 mg/dl vs. 0.82+ 0.18 mg/dl, p>0.05). 203 Both Serum total and indirect bilirubin were negatively associated with CVD in group A (p=0.001). On comparing patients with CVD and patients without CVD in group A, both serum total bilirubin level (0.64+0.1 mg/dl vs. 0.85+0.2 mg/dl, p=0.004) and serum indirect bilirubin level (0.49+0.1 mg/dl vs. 0.66+0.1 mg/dl, p=0.002) were lower in patients with CVD with statistically significant difference. Systolic blood pressure level (SBP) was significantly higher in patients with cardiovascular disease (151.1 +21.4 mmHg vs. 133.7 +20.8 mmHg, p=0.01). Also, within group A, SBP was significantly higher in patients with CVD (150.7 +23.4 mmHg vs. 125.5+17.5 mmHg, p=0.005). Stepwise regression analysis showed that Presence of CVD predicted decrease in serum total bilirubin by 0.17mg/dl and decrease in serum indirect bilirubin by 0.15mg/dl. Logistic regression analysis demonstrated that a rise in SBP by 10 mmHg increased the odds of having CVD by 50%, while, presence of hemodialysis increased the odds of having CVD by 6.6 folds. Logistic regression model demonstrated that decrease in serum total bilirubin by 0.1 mg/dl increased the odds of having CVD by 10%; however, there was multicolinearity problem, probably caused by the small number of the patients and linear correlation between studied variables. Further studies larger in size are required to prove or rule out serum bilirubin as an independent variable to CVD |