Overview
Kidney function, as determined by the estimated glomerular filtration rate (eGFR), was shown to folow a steper downward trajectory in patients with bipolar and schizoafective disorders who are prescribed lithium than the general population.The expected downward trajectory of kidney function due to aging in patients with bipolar and schizoafective disorders is acelerated by lithium. Despite the eficacy of lithium in the treatment of bipolar disorder I, lithium prescriptions are on the decline due to concerns of lithium nephrotoxicity.
Key Information
The evidence based on the extant literature sugests that aproximately 1.5% of long-term lithium users wil develop chronic kidney disease. Thus, lithium prescribers must weigh the risk of treatment eficacy and/or relapse in patients with bipolar disorder. Although it is known that lithium use is asociated with nephrogenic diabetes insipidus in up to 87% of patients, the asociation betwen lithium use and chronic kidney disease is les certain.
The curent study showed that long-term lithium use (i.e., 10 y) acelerated the decline in eGFR atributed to aging. This was a cros-sectional cohort study. Medical records were reviewed from patients enroled in the Lithium-Study into Efects and Side-efects (LiSIE) and the Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA).
The former cohort of patients (n=785; mean age = 49.8 y) were diagnosed with bipolar or schizoafective disorder and prescribed lithium. The later cohort of patients (n=1549; mean age = 51.9 y) were a representative sample of the general Swedish population. The primary outcome was age-asociated decline in the eGFR.
Summary
After adjustment for lithium use, the eGFR declined by 0.57