Hubungan Kadar Bilirubin Total dan Asam Urat dengan Kejadian Nefropati Diabetik pada Pasien DM Tipe 2

Abstract

Background: Type 2 diabetes mellitus (T2DM) is characterized by chronic hyperglycemia and may lead to diabetic nephropathy (DN) through mechanisms involving oxidative stress and inflammation. Bilirubin, an endogenous antioxidant, has been suggested to exert renoprotective effects, whereas uric acid may accelerate renal injury through its pro-oxidative properties. However, evidence regarding the roles of serum bilirubin and uric acid as markers of DN remains inconsistent. Objective: To examine the association between serum total bilirubin and uric acid levels and the occurrence of diabetic nephropathy in patients with T2DM. Methods: This cross-sectional study included 62 patients with T2DM treated at Adam Malik Hospital, Medan. Demographic data and laboratory parameters, including total bilirubin, uric acid, creatinine, estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio (UACR), were collected. Associations were analyzed using Spearman’s correlation and binary logistic regression. Results: No significant differences in baseline clinical characteristics were observed between patients with and without diabetic nephropathy (p > 0.05). Total bilirubin levels tended to be lower in the nephropathy group but did not reach statistical significance (p = 0.094). In contrast, serum uric acid levels were significantly higher in patients with diabetic nephropathy (p < 0.001). Total bilirubin showed a positive correlation with eGFR (r = 0.418; p = 0.001), whereas uric acid was negatively correlated with eGFR (r = −0.464; p < 0.001). Logistic regression analysis demonstrated that elevated uric acid levels were significantly associated with diabetic nephropathy (OR = 1.921; 95% CI: 1.267– 2.913; p = 0.002), while total bilirubin was not. Conclusion: Elevated serum uric acid levels are associated with impaired renal function in patients with T2DM, suggesting that uric acid may serve as a potential biomarker for diabetic nephropathy