Abstract
BackgroundSeveral studies have shown that long-term lithium use is associated with a subtle decline in estimated glomerular filtration rate. This study compared mean estimated glomerular filtration rates (eGFR) in patients on long term lithium, against matched controls.MethodsPatients with bipolar affective disorder, who are on lithium (for at least a year), were compared against controls that were matched (1:1) for age, gender and presence or absence of diabetes or hypertension. The eGFR was calculated from creatinine values according to the ‘modification of diet in renal disease study’ (MDRD) formula and was compared between cases and controls. A meta-analysis was performed to compare our findings with similar studies in literature.ResultsForty seven patients met the inclusion criteria. They were matched with 47 controls. The eGFR values of lithium users were significantly lower (p = 0.04) compared to controls. This difference persisted between the subgroup of lithium users without comorbidities (diabetes and hypertension) and their controls but disappeared for lithium users with comorbidities and their controls. Nonetheless, lithium users had lower eGFR values in both subgroups. A meta-analysis of 9 studies showed a significant lowering in the glomerular filtration rate in lithium users compared to controls [mean difference -10.3 ml/min (95% confidence interval: -15.13 to -5.55, p < 0.0001)].ConclusionsLithium causes a subtle decline in glomerular filtration rate; renal function needs to be monitored in patients on lithium treatment.
Highlights
Several studies have shown that long-term lithium use is associated with a subtle decline in estimated glomerular filtration rate
The objectives of this study were to compare the estimated glomerular filtration rates (eGFR) values of patients on long term lithium with controls matched for age, gender and comorbidities
Since the numbers were small in group B, they were used for an overall comparison of eGFR only (Table 2)
Summary
Several studies have shown that long-term lithium use is associated with a subtle decline in estimated glomerular filtration rate. This study compared mean estimated glomerular filtration rates (eGFR) in patients on long term lithium, against matched controls. Patients on long term lithium had significantly lower eGFR values (corrected for age and gender) [6] These observations raise the possibility of lithium contributing to a decline in GFR which may eventually lead to CKD. In view of this new evidence, and considering the large patient population currently on lithium, investigating whether long term lithium use causes a reduction in eGFR is timely. The objectives of this study were to compare the eGFR values of patients on long term lithium with controls matched for age, gender and comorbidities (diabetes and hypertension)
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