Lithium Treatment in Maintenance Dialysis

Abstract

The literature on lithium treatment during chronic dialysis is reviewed and a new case presented. In a patient suffering from bipolar affective disorder, onset of hemodialysis precipitated a manic episode. Oral lithium, given in single postdialysis doses, was well-tolerated, effective, and easy to handle. During 19 months of constant dosing, 10.8 mEq after each dialysis maintained steady-state predialysis levels at 0.50-0.77 mEq/L. Steady-state levels of the published cases were plotted against the maintenance doses and the regression function through the origin was calculated. From this, it is concluded that the average maintenance dose (in mEq), which is 18 times the desired predialysis level (in mEq/L), might serve as a starting dose, provided predialysis levels are closely monitored and doses readjusted accordingly. Preliminary evidence suggests that one to two weeks of constant dosing are needed to achieve steady-state, but that months or even years are required to fully assess the long-term fluctuations in lithium levels.

Real-World Clinical Practice Among Patients With Bipolar Disorder and Chronic Kidney Disease on Long-term Lithium Therapy

“…10 In addition, a study conducted by Kessing et al 11 identified that patients who continued Li, despite the CKD diagnosis, did not have an increased end-stage kidney disease rate compared with patients who discontinued Li and switched to a different mood stabilizer. Additional studies have shown successful use of Li in BD patients with hemodialysis [12][13][14][15] and suggested restarting Li use in cases of mood destabilization and when mental health deteriorates with alternative psychiatric treatments like mood stabilizing anticonvulsants (MSACs) and second-generation atypical antipsychotics (SGAs). However, at the same time, some authors have suggested discontinuing Li in patients with CKD stages 4 and 5 because of fear of worsening kidney function or Li toxicity.…”