Renal failure occurs in chronic lithium treatment but is uncommon

Abstract

We sought to establish the prevalence of lithium-induced end-stage renal disease in two regions of Sweden with 2.7 million inhabitants corresponding to about 30% of the Swedish population. Eighteen patients with lithium-induced end-stage renal disease were identified among the 3369 patients in the general lithium-treated population, representing a sixfold increase in prevalence compared with the general population for renal replacement therapy. All lithium-treated patients were older than 46 years at end-stage renal disease with a mean lithium treatment time of 23 years with ten patients having discontinued lithium treatment an average of 10 years before the start of renal replacement therapy. The prevalence of chronic kidney disease (defined as plasma creatinine over 150 micromol/l) in the general lithium-treated population was about 1.2% (excluding patients on renal replacement therapy). Compared with lithium-treated patients without renal failure, those with chronic kidney disease were older and most were men but, as groups, their mean serum lithium levels and psychiatric diagnoses did not differ. We found that end-stage renal disease is an uncommon but not rare consequence of long-term lithium treatment and is more prevalent than previously thought. Time on lithium was the only identified risk factor in this study, suggesting that regular monitoring of renal function in these patients is mandatory.

Lower Estimated Glomerular Filtration Rates in Patients On Long Term Lithium; a Comparative Study and a Meta-analysis of Literature

“…The investigators demonstrated that lithium users had a sixfold greater risk of needing renal replacement therapy compared with the general population [18]. However, the authors noted that end-stage kidney disease attributable to lithium is uncommon (only 18 patients were detected out of 3369 lithium treated patients).…”

Lithium in the Kidney: Friend and Foe?

“…Its prevalence in lithium-using patients was reported as approximately 1.5%, which is six to eight times higher than in the general population. 7,67 The duration of lithium treatment is an important factor, because the vast majority of patients with ESRD were treated for .15 years with lithium. 7,67 Although a report in 2014 suggested that the less-controlled treatment regime for lithium in the 1960s and 1970s strongly contributed to the development of ESRD, a later report showed that 5% of patients who started lithium treatment after 1980 and continued for 10-29 years also displayed evidence of ESRD.…”

“…7,67 The duration of lithium treatment is an important factor, because the vast majority of patients with ESRD were treated for .15 years with lithium. 7,67 Although a report in 2014 suggested that the less-controlled treatment regime for lithium in the 1960s and 1970s strongly contributed to the development of ESRD, a later report showed that 5% of patients who started lithium treatment after 1980 and continued for 10-29 years also displayed evidence of ESRD. 6,68 Whether this treatment regime reduces the occurrence of lithium-induced ESRD compared with the practices in the 1960s and 1970s remains to be addressed.…”

“…[69][70][71][72] Some lithium-treated patients also display glomerulosclerosis, but animal studies revealed that this pathology occurs after the onset of interstitial fibrosis and tubular atrophy. 7,69,[72][73][74][75] Although this suggests that glomerulosclerosis results from damage at other renal segments, it probably constitutes an essential step in the final progression to ESRD. 76 Other than these pathologic features, histology on biopsies or magnetic resonance imaging scans revealed that a number of lithium-treated patients also displays renal microcysts.…”

“…Dependent on dose and duration of treatment, long-term (decades) lithium therapy increases the chance to develop ESRD 6-to 8-fold. [5][6][7] Recently, two studies also reported an increased incidence of solid renal tumors in chronic lithium users compared with the general population. 8,9 However, because of several limitations of these studies as outlined by Licht et al 10 and contradictory findings in the study from Pottegård et al, 11 which included many more patients, we will not regard renal tumor development as a side effect of lithium treatment at this point.…”