Lithium usage and renal function testing in a large UK community population; a case-control study.
OBJECTIVE
This study investigates the prevalence of lithium use, monitoring practice and associated effects on renal function in a large UK community sample.


METHODS
A large population-based renal function database was cross-referenced with a general practitioner database of 404,673 patients. The renal function of patients prescribed lithium during the 2-year period was compared with that of matched controls. The renal monitoring patterns of these cases were investigated in a naturalistic observational study. Data underwent parametric testing - continuous variables by analysis of variance, with appropriate adjustment, and categorical outcomes by χ(2) testing. Block analysis of variance was undertaken on case-control data.


RESULTS
A total of 422 patients in the database were prescribed lithium. Renal function monitoring in accordance with published guidelines occurred in 69% of patients. Patients taking lithium had a significantly higher serum creatinine (5.8 μmol/L, P<.001) and lower glomerular filtration rate (5.9 ml/min, P<.001) when compared to matched controls.


CONCLUSIONS
This is the first study carried out in a large community sample. Lithium remains widely prescribed in the community setting. The study confirms that lithium has a statistically and clinically significant negative effect on renal function. Despite published guidelines and recognition of the importance of serial measurements, monitoring of renal function is inconsistent.
Department of Psychiatry, Windsor House, Belfast City Hospital, Belfast.
Jo
J
Minay
Raymond
R
Paul
Deirdre
D
McGarvey
Gerard
G
Savage
Mike
M
Stevenson
Damian
D
Fogarty
Ciaran
C
Mulholland
Christopher
C
Kelly
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D018692:Antimanic Agents / Q000009:adverse effects*; D001714:Bipolar Disorder / Q000188:drug therapy*; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006801:Humans; D007677:Kidney Function Tests; D018020:Lithium Compounds / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000139:chemically induced*; D006113:United Kingdom
D018692:Antimanic Agents; D018020:Lithium Compounds; D003404:Creatinine
Creatinine; Lithium; Monitoring; Prevalence; Renal function