Chronic kidney disease in lithium-treated patients, incidence and rate of decline

Arjan M Van Alphen,Ralph W Kupka,Rocco Hoekstra,Tessa M Bosch

doi:10.1186/s40345-020-00204-2

Abstract

BackgroundLithium-induced nephropathy is a known long-term complication, sometimes limiting the use of lithium as mood stabilizer. The aim of this study is to establish the incidence of chronic kidney disease and the rate of decline of renal function in patients using lithium and to identify risk factors.MethodsWe selected 1012 patients treated with lithium from the laboratory database of the Antes Centre for Mental Health Care spanning a period from 2000 to 2015. Serum lithium and creatinine concentrations were retrieved and eGFR was calculated using the 4-variable CKD-EPI formula. We calculated the incidence of renal insufficiency and the rate of decline. We compared patients with and without chronic kidney disease (CKD) stage 3 regarding duration of lithium exposure.ResultsIncidence of chronic kidney disease was 0.012 cases per exposed patient-year. Average decline of eGFR was 1.8 ml/min/year in patients who developed chronic kidney disease stage 3. Incidence of chronic kidney disease stage 4 was only 0.0004 per patient year. No cases of end stage renal disease were found in this cohort. Odds of reaching chronic kidney disease stage 3 were increased with longer duration of lithium exposure.ConclusionsThe use of lithium seems to be related to a higher incidence of chronic kidney disease. Longer duration of lithium exposure significantly increased the risk of renal failure.

Highlights

Lithium-induced nephropathy is a known long-term complication, sometimes limiting the use of lithium as mood stabilizer
Some uncertainty remains about the incidence of renal failure in patients treated with lithium salts
The aim of the present study is to establish the incidence of chronic kidney disease and the course of renal function in patients treated with lithium salts

Summary

Introduction

Lithium-induced nephropathy is a known long-term complication, sometimes limiting the use of lithium as mood stabilizer. The aim of this study is to establish the incidence of chronic kidney disease and the rate of decline of renal function in patients using lithium and to identify risk factors. Several reports suggest little effect of lithium on renal function, other studies estimate prevalence of chronic kidney disease (CKD) amongst lithium users between 10 and 35% (Presne et al 2003; Lepkifker et al 2004; Bassilios et al 2008; Bendz et al 2010; Aprahamian et al 2014; Aiff et al 2015; Tondo et al 2017).

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