title: Renal replacement therapy associated with lithium nephrotoxicity in Australia.
abstract: OBJECTIVE
  To analyse the annual incidence of end-stage renal disease (ESRD) associated with lithium-induced nephropathy (LiN) in Australia.
  
  
  METHODS
  Retrospective cohort study of patients commencing renal replacement therapy (RRT) in Australia. We compared patients with LiN with all other RRT patients between 1 January 1991 and 31 December 2011, using Australia and New Zealand Dialysis and Transplant Registry data.
  
  
  METHODS
  Numbers and characteristics of incident RRT patients, primary kidney disease (LiN or other, based on clinical diagnosis).
  
  
  RESULTS
  LiN contributed to 187 people in Australia commencing RRT between 1 January 1991 and 31 December 2011. The incidence rate increased from 0.14 cases/million population/year (95% CI, 0.06-0.22) in 1992-1996 to 0.78 (95% CI, 0.67-0.90) in 2007-2011. This increase is unlikely to be attributed solely to demographic changes in Australia. LiN patients were more likely than non-LiN patients to be women, to be white, to smoke, and to have a higher body mass index, but were less likely to have undergone renal biopsy.
  
  
  CONCLUSIONS
  Rates of ESRD attributed to LiN are increasing rapidly. Currently accepted lithium dosages and duration of treatment might induce ESRD in a large cohort of patients. We encourage clinicians to exercise discretion when prescribing lithium, check renal function regularly, stop lithium if there is a deterioration in two consecutive readings, and consider substitution with other drugs.
authors.affiliation: Concord Hospital, Sydney, NSW, Australia. blair@anzdata.org.au.
authors.forename: Milton
authors.initials: M
authors.lastname: Roxanas
authors.affiliation: Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia.
authors.forename: Blair S
authors.initials: BS
authors.lastname: Grace
authors.affiliation: Concord Hospital, Sydney, NSW, Australia.
authors.forename: Charles R P
authors.initials: CR
authors.lastname: George
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000139:chemically induced* / Q000453:epidemiology / Q000628:therapy; D016014:Linear Models; D008094:Lithium / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D012042:Registries; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D008094:Lithium