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. 2021 Nov;23(7):715-723.
doi: 10.1111/bdi.13052. Epub 2021 Mar 11.

Long-term lithium therapy and risk of chronic kidney disease in bipolar disorder: A historical cohort study

Mehak Pahwa  1 , Boney Joseph  1   2 , Nicolas A Nunez  1 , Gregory D Jenkins  3 , Colin L Colby  3 , Kianoush B Kashani  4 , Marin Veldic  1 , Katherine M Moore  1 , Hannah K Betcher  1 , Aysegul Ozerdem  1 , Alfredo B Cuellar-Barboza  1   5 , Susan L McElroy  6 , Joanna M Biernacka  1   3 , Mark A Frye  1 , Balwinder Singh  1
Affiliations

Long-term lithium therapy and risk of chronic kidney disease in bipolar disorder: A historical cohort study

Mehak Pahwa et al. Bipolar Disord. 2021 Nov.

Abstract

Aims: Long-term lithium therapy (LTLT) has been associated with kidney insufficiency in bipolar disorder (BD). We aimed to investigate the risk factors of chronic kidney disease (CKD) development and progression among BD patients receiving LTLT.

Methods: We included adult patients with BD on LTLT (≥1 year) who were enrolled in the Mayo Clinic Bipolar Biobank, Rochester, Minnesota. We reviewed electronic medical records to extract information related to lithium therapy and kidney-related data to assess changes in the estimated glomerular filtration rate (eGFR). CKD severity was assessed based on eGFR.

Results: Among 154 patients who received LTLT, 41 patients (27%) developed CKD, of whom 20 (49%) patients continued lithium (continuers) and 19 (46%) discontinued it (discontinuers). The median time to stage 3 CKD development was 21.7 years from the start of Li treatment. Type-2 diabetes mellitus and benzodiazepine use were independent predictors for CKD development in the survival analysis, after controlling for age. The subsequent CKD progression rate did not differ between continuers and discontinuers (mean GFR 48.6 vs. 44.1, p = 0.13) at the end of follow-up duration (mean duration: 3.5 ± 4.4 years for continuers and 4.9 ± 5.3 years for discontinuers).

Conclusion: CKD was observed in one fourth of patients with BD receiving LTLT. There was no significant difference in the progression of CKD among Li continuers versus discontinuers, at the mean follow-up duration of 4.2 years, after the CKD diagnosis. Progression of CKD could be influenced by existing comorbidities and may not necessarily be due to lithium alone.

Keywords: bipolar depression; chronic kidney disease; lithium; mood disorders; retrospective studies.

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References

REFERENCES

    1. Nivoli AM, Murru A, Vieta E. Lithium: Still a cornerstone in the long-term treatment in bipolar disorder? Neuropsychobiology. 2010;62(1):27-35.
    1. Severus E, Taylor MJ, Sauer C, et al. Lithium for prevention of mood episodes in bipolar disorders: systematic review and meta-analysis. Int J Bipolar Disord. 2014;2:15.
    1. Geddes JR, Burgess S, Hawton K, Jamison K, Goodwin GM. Long-term lithium therapy for bipolar disorder: Systematic review and meta-analysis of randomized controlled trials. Am J Psychiatry. 2004;161(2):217-222.
    1. Baldessarini RJ, Leahy L, Arcona S, Gause D, Zhang W, Hennen J. Patterns of psychotropic drug prescription for U.S. patients with diagnoses of bipolar disorders. Psychiatr Serv. 2007;58(1):85-91.
    1. Gitlin M. Lithium and the kidney: An updated review. Drug Saf. 1999;20(3):231-243.