A new study published in BMC Nephrology examined the role of total bilirubin as a potential clinical marker in adults undergoing maintenance hemodialysis. Researchers found that total bilirubin functioned as an independent predictor of all-cause mortality in this population. Their analysis showed that patients with lower bilirubin levels faced a higher mortality risk, suggesting that bilirubin may reflect underlying oxidative stress or impaired physiological resilience in chronic kidney disease. The authors highlighted that bilirubin, a routinely measured parameter, may offer additional prognostic value without adding cost or complexity to clinical workflows.
The investigation also explored whether the predictive strength of bilirubin varied by age. Findings indicated that the association between bilirubin levels and mortality appeared stronger in non-elderly hemodialysis patients. This pattern suggests that younger individuals on long-term dialysis may be more physiologically sensitive to bilirubin-related pathways or that bilirubin may better capture risk in patients who have fewer competing comorbidities. While the biological mechanisms remain to be clarified, the researchers proposed that oxidative balance and inflammatory load—both reflected in bilirubin physiology—may play a larger role in survival outcomes among younger MHD patients.
The authors concluded that total bilirubin could serve as a useful and accessible biomarker for risk stratification in maintenance hemodialysis. They recommended future prospective studies to validate these findings and to determine whether monitoring bilirubin trends could support clinical decision-making or early intervention strategies. Because bilirubin measurement is already part of standard biochemical testing, integrating it into mortality risk assessments may be practical and immediately applicable across dialysis centers.
Keywords: total bilirubin, maintenance hemodialysis, mortality risk, prognostic biomarker, oxidative stress, BMC Nephrology
Reference: Zhao, Y., Liu, F., Chen, H., & Wu, X. (2025). Total bilirubin as a predictor of all-cause mortality in patients undergoing maintenance hemodialysis. BMC Nephrology. https://doi.org/10.1186/s12882-025-04621-2
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