Lithium and Renal Impairment: A Review on a Still Hot Topic

TY - JOUR

T1 - Lithium and Renal Impairment

T2 - A Review on a Still Hot Topic

AU - Nielsen, René Ernst

AU - Kessing, Lars Vedel

AU - Nolen, Willem A

AU - Licht, Rasmus W

N1 - © Georg Thieme Verlag KG Stuttgart · New York.

PY - 2018/1/18

Y1 - 2018/1/18

N2 - INTRODUCTION: Lithium is established as an effective treatment of mania, of depression in bipolar and unipolar disorder, and in maintenance treatment of these disorders. However, due to the necessity of monitoring and concerns about irreversible adverse effects, in particular renal impairment, after long-term use, lithium might be underutilized.METHODS: This study reviewed 6 large observational studies addressing the risk of impaired renal function associated with lithium treatment and methodological issues impacting interpretation of results.RESULTS: An increased risk of renal impairment associated with lithium treatment is suggested. This increased risk may, at least partly, be a result of surveillance bias. Additionally, the earliest studies pointed toward an increased risk of end-stage renal disease associated with lithium treatment, whereas the later and methodologically most sound studies do not.DISCUSSION: The improved renal outcome found in the more recent lithium studies may be a result of improved monitoring and focus on recommended serum levels (preferentially 0.6-0.8 mmol/L) as compared to poorer renal outcome in studies with patients treated in the 1960s to 1980s.

AB - INTRODUCTION: Lithium is established as an effective treatment of mania, of depression in bipolar and unipolar disorder, and in maintenance treatment of these disorders. However, due to the necessity of monitoring and concerns about irreversible adverse effects, in particular renal impairment, after long-term use, lithium might be underutilized.METHODS: This study reviewed 6 large observational studies addressing the risk of impaired renal function associated with lithium treatment and methodological issues impacting interpretation of results.RESULTS: An increased risk of renal impairment associated with lithium treatment is suggested. This increased risk may, at least partly, be a result of surveillance bias. Additionally, the earliest studies pointed toward an increased risk of end-stage renal disease associated with lithium treatment, whereas the later and methodologically most sound studies do not.DISCUSSION: The improved renal outcome found in the more recent lithium studies may be a result of improved monitoring and focus on recommended serum levels (preferentially 0.6-0.8 mmol/L) as compared to poorer renal outcome in studies with patients treated in the 1960s to 1980s.

KW - Antimanic Agents/adverse effects

KW - Humans

KW - Kidney Diseases/chemically induced

KW - Lithium Compounds/adverse effects

KW - Mood Disorders/drug therapy

KW - Observational Studies as Topic

KW - Randomized Controlled Trials as Topic

U2 - 10.1055/s-0043-125393

DO - 10.1055/s-0043-125393

M3 - Review

C2 - 29346806

SN - 0176-3679

VL - 51

SP - 200

EP - 205

JO - Pharmacopsychiatry

JF - Pharmacopsychiatry

IS - 5

ER -