Circulating bilirubin and defense against kidney disease and cardiovascular mortality: mechanisms contributing to protection in clinical investigations

Unconjugated bilirubin is an endogenous circulating antioxidant, bound to albumin, and therefore is retained in the vascular compartment. Bilirubin has well-documented neurotoxic effects in infants; however, current evidence indicates mildly elevated bilirubin is associated with protection from card...

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Bibliographic Details
Published in:American journal of physiology. Renal physiology 2014-07, Vol.307 (2), p.F123-F136
Main Authors: Boon, Ai-Ching, Bulmer, Andrew C, Coombes, Jeff S, Fassett, Robert G
Format: Article
Language:English
Subjects:
Animals
Antioxidants
Babies
Bilirubin - blood
Biomarkers - blood
Cardiovascular disease
Cardiovascular Diseases - blood
Cardiovascular Diseases - mortality
Cardiovascular Diseases - physiopathology
Cardiovascular Diseases - prevention & control
Disease Progression
Humans
Kidney - metabolism
Kidney - physiopathology
Kidney diseases
Kidney Diseases - blood
Kidney Diseases - mortality
Kidney Diseases - physiopathology
Kidney Diseases - therapy
Mortality
Renal Dialysis - adverse effects
Renal Dialysis - mortality
Risk Assessment
Risk Factors
Treatment Outcome
Up-Regulation
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Summary:Unconjugated bilirubin is an endogenous circulating antioxidant, bound to albumin, and therefore is retained in the vascular compartment. Bilirubin has well-documented neurotoxic effects in infants; however, current evidence indicates mildly elevated bilirubin is associated with protection from cardiovascular disease and all-cause mortality in adults. Recent clinical studies show mildly elevated bilirubin is associated with protection from kidney damage and dysfunction, in addition to cardiovascular events and all-cause mortality in patients undergoing hemodialysis. This is the first review to examine the clinical evidence and summarize the potential mechanisms of action that link bilirubin to protection from kidney damage, subsequent kidney failure, and dialysis-related mortality. With this understanding, it is hoped that new therapies will be developed to prevent renal dysfunction and mortality from cardiovascular disease in at-risk individuals.
ISSN:1931-857X
1522-1466
DOI:10.1152/ajprenal.00039.2014