ArticleBMC nephrology2026
Gender-specific associations between serum indirect bilirubin and chronic kidney disease risk: a prospective cohort study highlighting a protective effect confined to males.
Article in BMC nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCurrent evidence remains limited regarding associations between serum indirect bilirubin (IBIL) levels and chronic kidney disease (CKD) risk, particularly in gender-stratified analyses. This study investigated the gender-specific relationship between serum IBIL and CKD incidence.
methodsUsing data from a prospective cohort in northwestern China, we followed 25,684 CKD-free participants. Cox proportional hazards models and restricted cubic spline regression were employed to assess IBIL-CKD associations. The discriminatory performance of IBIL was evaluated through ROC curve analysis. Robustness of results was examined via subgroup and sensitivity analyses.
resultsOver 122,401.17 person-years of follow-up, 1,219 incident CKD cases were identified. Adjusted hazard ratios (95% CIs) for CKD were 0.799 (0.679–0.940) overall and 0.718 (0.693–0.869) among males. Area under the curve (AUC) values were 0.710 (0.704–0.715; p < 0.001) overall, 0.710 (0.703–0.718; p < 0.001) for males, and 0.679 (0.670–0.688; p < 0.001) for females. A formal test for interaction confirmed that the association was significantly modified by sex (p for interaction < 0.001). A linear dose-response pattern was observed exclusively in males. Results remained consistent across subgroup and sensitivity analyses.
conclusionsOur findings reveals a significant sex interaction in the association between serum IBIL and CKD. The inverse association is robust, exhibits a linear dose-response relationship, and is statistically significant exclusively in males. These findings position serum IBIL as a sexually dimorphic factor linked to CKD risk, underscoring the necessity of considering gender in both the research and potential risk assessment of oxidative stress-related pathways in renal disease.
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