الفهرس 
Diabetes mellitusOnly 14 pages are availabe for public view
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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
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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).
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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