Evidence mapPaperPMID 42494200Full record

ArticleJournal of diabetes research2026

Association of Serum Bilirubin Levels With Histopathological Severity of Diabetic Nephropathy in Patients With Type 2 Diabetes: A Cross-Sectional Biopsy Study.

Xiaorong Wang, Congqin Zhang, Chunxia Zhang, Yongmei Hao, Lingling Xing, Chang Guo, Lin Mu

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Article in Journal of diabetes research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

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3 · Its place in the literature

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1 citing paper in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Xiaorong WangDepartment of Nephrology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China, hebmu.edu.cn.ORCID https://orcid.org/0009-0000-0009-8704
Congqin ZhangDepartment of Nephrology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China, hebmu.edu.cn.ORCID https://orcid.org/0009-0006-9282-9319
Chunxia ZhangDepartment of Nephrology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China, hebmu.edu.cn.
Yongmei HaoDepartment of Endocrinology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China, hebmu.edu.cn.ORCID https://orcid.org/0000-0003-3668-7310
Lingling XingDepartment of Nephrology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China, hebmu.edu.cn.ORCID https://orcid.org/0000-0003-4749-707X
Chang GuoDepartment of Medical Oncology, Affiliated Hospital of Hebei University, Baoding, Hebei, China, hbu.cn.ORCID https://orcid.org/0009-0008-1320-4885
Lin MuDepartment of Nephrology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China, hebmu.edu.cn.ORCID https://orcid.org/0000-0003-2814-253X

Funding

Hebei Provincial Medical Science Research Project 20220984
6 · The paper itself

Abstract

backgroundPrior studies have suggested that serum total bilirubin (TBil) may be linked to diabetic nephropathy (DN); however, its potential relationship with structural renal injury in histopathology has not been well defined.

objectiveThe objective of the study is to explore whether physiological levels of TBil are associated with the severity of renal pathological changes in individuals with Type 2 diabetes mellitus (T2DM) and biopsy-confirmed DN.

methodsA cross-sectional cohort of 401 individuals with T2DM and biopsy-confirmed DN was included. DN severity was determined according to the Renal Pathology Society classification and categorized as early-stage DN (Classes I-II) or advanced DN (Classes III-IV). Multivariable logistic regression was used to evaluate the association between TBil and advanced DN. TBil quartiles, restricted cubic spline modeling, subgroup and sensitivity analyses, and receiver operating characteristic curve analysis were also performed.

resultsAmong 401 biopsy-confirmed DN patients, 258 (64.3%) were classified as having advanced DN. In multivariable models, higher TBil levels were independently associated with lower odds of advanced DN after full adjustment (OR = 0.882, 95% CI 0.827-0.941; p < 0.001). When TBil was analyzed by quartiles, individuals in the highest quartile exhibited significantly lower odds of advanced-stage disease relative to those in the lowest quartile in the fully adjusted model (OR = 0.331, 95% CI 0.153-0.718; p = 0.005), with a notable dose-response pattern across quartiles (p for trend = 0.003). Restricted cubic spline analyses confirmed an inverse association between TBil levels and advanced DN. Receiver operating characteristic curve analysis identified a TBil cutoff of 9.9 μmol/L for discriminating advanced DN, with an area under the curve of 0.684. The results were broadly consistent across subgroup and sensitivity analyses.

conclusionHigher physiological TBil levels were linked to lower histopathological severity of DN in patients with Type 2 diabetes.

Indexed as

BilirubinDiabetes Mellitus, Type 2Diabetic NephropathiesKidneyAdultAgedBiomarkersBiopsyCross-Sectional StudiesFemaleHumansMaleMiddle AgedROC CurveSeverity of Illness IndexBilirubinBiomarkersdiabetic nephropathyhistopathological severityrenal biopsytotal bilirubinType 2 diabetes mellitus

Identifiers

PMID42494200
PMCPMC13396876

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.