Lithium acetate therapy in a maintenance hemodialysis patient.
OBJECTIVE
Single cases of lithium carbonate dosing in hemodialysis patients have been published. We investigate the dose-serum level relationship after single and multiple lithium acetate dosing in a hemodialysis patient and review the literature.


METHODS
Lithium acetate was administered orally over a period of 11 months in a patient with major depressive episodes after being placed on hemodialysis three times a week. The serum trough levels of lithium before and after hemodialysis were analyzed. The data were compared with those reported in the literature, and potential drug interactions and the importance of the residual renal function are discussed.


RESULTS
No adverse events due to the lithium therapy were documented. Steady state levels of between 0.6 and 0.8 mmol/l of lithium acetate were achieved 17 days after initiating the therapy, using 24 mmol/l of lithium three times a week, in a patient with a residual diuresis of about 400 ml/day. In contrast, data reported in the literature implicate that only 9.6-14.4 mmol/l of lithium (450-600 mg of lithium carbonate) is sufficient to achieve adequate serum levels.


CONCLUSIONS
The residual renal function can be important for lithium clearance. The creatinine clearance does not reflect this point.
Walcher
Judith
J
Department of Nephrology, University of Kiel, Germany.
Schoecklmann
Harald
H
Renders
Lutz
L
D000085:Acetates / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics; D000928:Antidepressive Agents / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics; D003865:Major Depressive Disorder / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008875:Middle Aged; D006435:Renal Dialysis
D000085:Acetates; D000928:Antidepressive Agents; C488804:lithium acetate