Effects of 10 to 30 years of lithium treatment on kidney function.
Long-term lithium treatment is associated with end-stage renal disease, but there is little evidence of a clinically significant reduction in renal function in most patients. We previously found that 1.5% of people who took lithium from the 1960s and 1970s developed end-stage renal disease; however, none of the patients who started after 1980 had end-stage renal disease. Here we aimed to study the prevalence and extent of kidney damage during the course of long-term lithium treatment since 1980. We retrieved serum lithium and creatinine levels from 4879 patients examined between 1 January 1981 and 31 December 2010. Only patients who started their lithium treatment during the study period and had at least 10 years of cumulative treatment were included. The study group comprised 630 adult patients (402 women and 228 men) with normal creatinine levels at the start of lithium treatment. There was a yearly increase in median serum creatinine levels already from the first year of treatment. About one-third of the patients who had taken lithium for 10-29 years had evidence of chronic renal failure but only 5% were in the severe or very severe category. The results indicate that a substantial proportion of adult patients who are treated with lithium for more than a decade develop signs of renal functional impairment, also when treated according to modern therapeutic principles. Our results emphasise that lithium treatment requires continuous monitoring of kidney function.
Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden harald.aiff@neuro.gu.se.
Harald
H
Aiff
Department of Nephrology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Per-Ola
PO
Attman
Department of Nephrology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Mattias
M
Aurell
Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden.
Hans
H
Bendz
Department of Nephrology, Skaraborg Hospital, Skövde, Sweden.
Bernd
B
Ramsauer
Diaverum Renal Services Group, Lund & Swedish Renal Registry, Jönköping, Sweden.
Staffan
S
Schön
Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Jan
J
Svedlund
D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000494:pharmacology* / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000139:chemically induced* / Q000503:physiopathology; D008094:Lithium / Q000009:adverse effects* / Q000097:blood / Q000494:pharmacology* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D012189:Retrospective Studies
D014150:Antipsychotic Agents; D008094:Lithium; D003404:Creatinine
Lithium; adverse effects; bipolar disorder; chronic; kidney disease; renal failure