The albumin–bilirubin score is associated with renal decline in diabetic kidney disease: a retrospective study

Background The albumin–bilirubin (ALBI) score, originally developed to assess hepatic reserve, has shown prognostic value in liver and systemic diseases. Whether the ALBI score is associated with diabetic kidney disease (DKD) progression remains unclear. Methods We conducted a retrospective single-centre study including 113 patients with DKD hospitalized between January 2016 and May 2023. The ALBI score was calculated from serum albumin and total bilirubin. Patients were followed for 2–7 years, and DKD progression was evaluated by annual percentage change in estimated glomerular filtration rate (eGFR). Associations between the ALBI score quartiles and renal outcomes were assessed using correlation analyses, logistic regression, and receiver operating characteristic (ROC) curves. Results A total of 113 patients with DKD were included in the analysis. Higher ALBI score was associated with a more rapid annual decline in eGFR and greater urinary protein excretion. Across ALBI quartiles, the annual percentage change in eGFR differed significantly, and 24-h urine total protein quantification (UTP) increased progressively with increasing quartiles. Correlation analysis showed that the ALBI score was positively correlated with UTP and negatively correlated with annual percentage change in eGFR. ROC analysis suggested an exploratory cut-off value of −2.2350 (area under the curve (AUC) = 0.656, P = 0.004) for distinguishing patients with rapid eGFR decline, although the discriminatory performance was modest, and this threshold has not been clinically validated. After multivariable adjustment, higher ALBI score quartiles remained significantly associated with rapid eGFR decline ( P for trend = 0.024). In the adjusted Model 3, compared with Quartile 1, only Quartile 4 remained significantly associated with rapid eGFR decline, whereas Quartiles 2 and 3 did not reach statistical significance. Conclusions This study suggests that the ALBI score was associated with DKD progression and may serve as a potential supplementary indicator for identifying patients at higher risk of rapid eGFR decline.