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Observational Study
. 2023 Sep;25(6):499-506.
doi: 10.1111/bdi.13302. Epub 2023 Feb 1.

Quality of laboratory biomarker monitoring during treatment with lithium in patients with bipolar disorder

Alessandro Bosi  1 , Laura Ceriani  1   2 , Carl-Gustaf Elinder  3 , Rino Bellocco  1   2 , Catherine M Clase  4 , Mikael Landen  1   5 , Juan-Jesus Carrero  1   6 , Björn Runesson  7
Affiliations
Observational Study

Quality of laboratory biomarker monitoring during treatment with lithium in patients with bipolar disorder

Alessandro Bosi et al. Bipolar Disord. 2023 Sep.

Abstract

Background: Clinical guidelines recommend monitoring of creatinine and lithium throughout treatment with lithium. We here assessed the extent to which this occurs in healthcare in Sweden.

Methods: This is an observational study of all adults with bipolar disorder starting lithium therapy in Stockholm, Sweden, during 2007-2018. The main outcome was monitoring of blood lithium and creatinine at therapy initiation and/or once annually. The secondary outcome was monitoring of calcium and thyroid-stimulating hormone (TSH). Patients were followed up until therapy cessation, death, out-migration, or to the end of 2018.

Results: We identified 4428 adults with bipolar disorder who started lithium therapy and were followed up for up to 11 years. Their median age was 39 years, and 63% were women. The median duration on lithium therapy was 4.3 (IQR: 1.9-7.45) years, and the majority who discontinued therapy started another mood stabilizer soon after. Overall, 21% started lithium therapy without assessing the serum/plasma concentration of creatinine. The proportion of people who did not have both lithium and creatinine measured increased from 21% in the first year to 33% in the eleventh year. The proportion with annual testing for TSH or calcium was slightly lower. As few as 16% of patients had both lithium and creatinine tested once annually during their complete time on lithium.

Conclusions: In a Swedish community sample, lithium and creatinine monitoring was inconsistent with guideline recommendations that call for measurement of annual biomarker levels.

Keywords: Adverse drug events; SCREAM; creatinine; lithium; monitoring; nephrotoxicity.

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References

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