Renal replacement therapy associated with lithium nephrotoxicity in Australia

Abstract

Rates of ESRD attributed to LiN are increasing rapidly. Currently accepted lithium dosages and duration of treatment might induce ESRD in a large cohort of patients. We encourage clinicians to exercise discretion when prescribing lithium, check renal function regularly, stop lithium if there is a deterioration in two consecutive readings, and consider substitution with other drugs.

One lithium level >1.0 mmol/L causes an acute decline in eGFR: findings from a retrospective analysis of a monitoring database

“…Currently this analysis suggests that even short-term exposure to elevated lithium levels has a significant impact on glomerular renal function in the first 3 months following exposure, and regular monitoring of lithium levels and timely responses to these levels is critical. 19 It is still not known whether the kidneys can fully recover this lost function or if the effects of multiple exposures are additive; as such we suggest that lithium level monitoring should be undertaken at least every 3 months, in line with current UK guidelines, and not be reduced further until the impact of more than one exposure to these lithium levels has been fully established. A small change in GFR of 5 mL/min in an individual patient may well be due to variability in measurement of plasma creatinine, and is unlikely to lead to any action, unless it was sustained or there was further deterioration, which is another reason for regular monitoring.…”

Lithium for bipolar disorder: a review of the recent literature

“…The incidence of lithium associated CRD and ESRD was previously unclear, but new epidemiological data and metaanalyses provide useful information [97,102]. The previously mentioned Swedish study looked for lithium-induced ESRD in a population of 2.7 million and found a sixfold increase in the rate of renal replacement therapy in those treated with lithium; however, the absolute risk was small (18 of 3369 or 0.5%) [98].…”

“…The improved understanding of lithium-induced renal effects highlights the importance of regular renal monitoring for anyone taking lithium [97,98,100] and particularly for those who have taken it for many years [97]. Prescribers should strive to use the lowest effective lithium dose, since the optimal dosing regimen to prevent renal disease remains unclear [103].…”

“…Although lithium's renal effects have previously been debated [97], it is now well established that chronic and endstage renal disease (ESRD) are uncommon outcomes of longterm lithium therapy [98][99][100][101]. The nephropathy is typically asymptomatic and usually develops 10-20 years after the medication is initiated, but occasionally occurs earlier [101].…”

Renal replacement therapy associated with lithium nephrotoxicity in Australia

“…To the Editor : The article by Roxanas and colleagues 1 is a welcome addition to the body of literature that clearly demonstrates a causal relationship between lithium use and chronic renal failure. The recommendation to monitor renal function 6‐monthly and be hypervigilant to deteriorating renal function is sound clinical advice.…”