Lithium Nephrotoxicity: When Is the Time for Nephrology Consultation?
Year: 2016
Type: article
Study design: Observational Study
Abstract: Dear Editor-in-chiefEnd-stage renal disease (ESRD) is one possible consequence of chronic kidney disease (CKD) that causes costly renal replacement therapy in the context of dialysis or kidney transplantation. Improved awareness of CKD risk factors has led to decrease the incidence of ESRD in developed countries, whereas no tangible change is being observed in developing countries (1).A rising body of evidence advocates that the lack of adequate care exist among people with mental illnesses. The average life span of patients with severe mental disorder is 25 years less than that of the general population, and 60% of premature deaths arises from preventable reasons. Patients with mental illness have fewer regular preventive facilities, poorer diabetic control, lower number of cardiovascular procedures performed, and less compliance with renal replacement therapy (2). Considering that lithium therapy could be a hidden risk factor contributing to renal dysfunction in bipolar affective disorder, investigating and heightened awareness of lithium renal abnormalities are warranted (3).This study was performed in the Iran Psychiatry Hospital in Tehran, Iran. This cross sectional study was approved by Ethics Committee of Iran University of Medical Sciences. All cases provided written informed consent before study registration.Patients with a diagnosis of bipolar disorder (ICD, 10th edition), over the age of 18 yr who underwent lithium therapy for at least 3 months were included. Patients were excluded if they had diabetic nephropathy, hypertension, renal failure, and history of NSAID, ACEIs or ARB and diuretic use. Data on duration of lithium therapy, urine osmolarity, serum calcium concentration, serum creatinine and BUN were collected. Polyuria was defined as urine volume above 3 L /24 h. Hypercalcemia was defined as a serum calcium concentration ≥ 10.4 mg/dL. Urine osmolarity ≤350 mosm/L was considered abnormal. Estimated Glomerular Filtration Rate (eGFR) was applied to classify kidney disease staging which was calculated using the Cockcroft and Gault formula (4). Stages of CKD were defined according to the National Kidney Foundation criteria (K/DOQI Clinical Practice Guidelines).Fifty-five patients were enrolled in the study. No statistically significant differences were observed between the two groups in terms of demographic data and clinical characteristics. The estimated mean dose of lithium carbonate was 954 ± 522 mg. Mean lithium therapy duration was 83.38 ± 11.00 months.Polyuria was observed in 10/55 of patients. Hypercalcemia was observed in 9/55 of patients. Abnormal urine osmolarity was detected in 46/55 of patients. Stage 2 and 3 of CKD were identified in 14/ 55 and 1/55 of patients, respectively.Patients who received lithium for a longer time had significantly lower eGFR. Furthermore, relation between duration of lithium therapy and reduced urine osmolarity was significant. Patients who treated by higher daily dose of lithium had significantly lower eGFR and diminished urine osmolarity, respectively. Higher stages of CKD were directly correlated with the duration of lithium therapy.In this study, patients who underwent lithium therapy were at risk for various types of renal abnormalities including CKD. About 84% of our patients had polyuria and diminished urine osmolarity which might be due to lithium induced nephrogenic diabetes insipidus or in the course of CKD progression. Stage 2 and 3 of CKD were observed in 25% and about 2% of patients, respectively. …
Source: Europe PMC (PubMed Central)
Authors: Shokoufeh Savaj, Maryam Farasatinasab, Atefeh Amouzegar, Maryam Rahimi, Mohammad Hosseinzadeh
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2517774381