Long-term lithium treatment is associated with end-stage renal disease, but there is little evidence of a clinically significant reduction in renal function in most patients. We previously found that 1.5% of people who took lithium from the 1960s and 1970s developed end-stage renal disease; however, none of the patients who started after 1980 had end-stage renal disease. Here we aimed to study the prevalence and extent of kidney damage during the course of long-term lithium treatment since 1980. We retrieved serum lithium and creatinine levels from 4879 patients examined between 1 January 1981 and 31 December 2010. Only patients who started their lithium treatment during the study period and had at least 10 years of cumulative treatment were included. The study group comprised 630 adult patients (402 women and 228 men) with normal creatinine levels at the start of lithium treatment. There was a yearly increase in median serum creatinine levels already from the first year of treatment. About one-third of the patients who had taken lithium for 10–29 years had evidence of chronic renal failure but only 5% were in the severe or very severe category. The results indicate that a substantial proportion of adult patients who are treated with lithium for more than a decade develop signs of renal functional impairment, also when treated according to modern therapeutic principles. Our results emphasise that lithium treatment requires continuous monitoring of kidney function.

Aiff H, Attman PO, Aurell M, . (2014a) End-stage renal disease associated with prophylactic lithium treatment. Eur Neuropsychopharmacol 24: 540544. Google Scholar CrossRef, Medline
Aiff H, Attman PO, Aurell M, . (2014b) The impact of modern treatment principles may have eliminated lithium-induced renal failure. J Psychopharmacol 28: 151154. Google Scholar Link
Baigent C, Burbury K, Wheeler D (2000) Premature Cardiovascular disease in chronic renal failure. Lancet 356: 147152. Google Scholar CrossRef, Medline
Baldessarini RJ, Tondo L, Davis P, . (2006) Decreased risk of suicides and attempts during long-term lithium treatment: A meta-analytic review. Bipolar Disord 8: 625639. Google Scholar CrossRef, Medline
Bassilios N, Martel P, Godard V, . (2008) Monitoring of glomerular filtration rate in lithium-treated outpatients – an ambulatory laboratory database surveillance. Nephrol Dial Transplant 23: 562565. Google Scholar CrossRef, Medline
Bendz H, Aurell M, Balldin J, . (1994) Kidney damage in long-term lithium patients: A cross-sectional study of patients with 15 years or more on lithium. Nephrol Dial Transplant 9: 12501254. Google Scholar Medline
Bendz H, Aurell M, Lanke J (2001) A historical cohort study of kidney damage in long-term lithium patients: Continued surveillance needed. Eur Psychiatry 16: 199206. Google Scholar CrossRef, Medline
Björk J, Grubb A, Sterner G, . (2011) Revised equations for estimating glomerular filtration rate based on the Lund–Malmo study cohort. Scand J Clin Lab Invest 71: 232239. Google Scholar CrossRef, Medline
Cipriani A, Hawton K, Stockton S, . (2013) Lithium in the prevention of suicide in mood disorders: Updated systematic review and meta-analysis. BMJ 346: f3646. Google Scholar CrossRef, Medline
Close H, Reilly J, Mason JM, . (2014) Renal failure in lithium-treated bipolar disorder: A retrospective cohort study. PLoS One 9: e90169. Google Scholar CrossRef, Medline
Crump C, Sundquist K, Winkleby MA, . (2013) Comorbidities and mortality in bipolar disorder: A Swedish national cohort study. JAMA Psychiatry 70: 931939. Google Scholar CrossRef, Medline
Geddes JR, Miklowitz DJ (2013) Treatment of bipolar disorder. Lancet 381: 16721682. Google Scholar CrossRef, Medline
Go AS, Chertow GM, Fan D, . (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351: 12961305. Google Scholar CrossRef, Medline
Lepkifker E, Sverdlik A, Iancu I, . (2004) Renal insufficiency in long-term lithium treatment. J Clin Psychiatry 65: 850856. Google Scholar CrossRef, Medline
Mccann SM, Daly J, Kelly CB (2008) The impact of long-term lithium treatment on renal function in an outpatient population. Ulster Med J 77: 102105. Google Scholar Medline
Mcknight RF, Adida M, Budge K, . (2012) Lithium toxicity profile: a systematic review and meta-analysis. Lancet 379: 721728. Google Scholar CrossRef, Medline
NKF (2002) K/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Am J Kidney Dis 39: 1266. Google Scholar Medline
NORIP (2014) Nordic Reference Interval Project. Available at: pweb.furst.no/norip (accessed 2 February 2014). Google Scholar
Paul R, Minay J, Cardwell C, . (2010) Meta-analysis of the effects of lithium usage on serum creatinine levels. J Psychopharmacol 24: 14251431. Google Scholar Link
Presne C, Fakhouri F, Noel LH, . (2003) Lithium-induced nephropathy: Rate of progression and prognostic factors. Kidney Int 64: 585592. Google Scholar CrossRef, Medline
SBU (2013) Methods to Estimate and Measure Renal Function (Glomerular Filtration Rate). Stockholm: Swedish Council on Health Technology Assessment. Google Scholar
Tredget J, Kirov A, Kirov G (2010) Effects of chronic lithium treatment on renal function. J Affect Disord 126: 436440. Google Scholar CrossRef, Medline

Vol 29, Issue 5, 2015

Recommended Citation

Effects of 10 to 30 years of lithium treatment on kidney function

David J Nutt, Pierre BlierHarald Aiff1, Per-Ola Attman2, Mattias Aurell2, Hans Bendz3, Bernd Ramsauer4, Staffan Schön5, Jan Svedlund1Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenDepartment of Nephrology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenDepartment of Clinical Sciences, Psychiatry, Lund University, Lund, SwedenDepartment of Nephrology, Skaraborg Hospital, Skövde, SwedenDiaverum Renal Services Group, Lund & Swedish Renal Registry, Jönköping, Sweden

Journal of Psychopharmacology

Vol 29, Issue 5, pp. 608 - 614

First published date: March-03-2015

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David J Nutt, Pierre BlierHarald Aiff, Per-Ola Attman, Mattias Aurell, Hans Bendz, Bernd Ramsauer, Staffan Schön, Jan Svedlund
Journal of Psychopharmacology 2015 29:5, 608-614

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