Successful lithium treatment in a patient on hemodialysis

Engels, Noel; Alphen, Adriaan M. van; Bosch, Tessa M.; Hoekstra, Rocco

doi:10.1111/bdi.12756

Cited by 8 publications

(31 citation statements)

References 4 publications

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“…8,12 Three patients eventually underwent renal allograft and some required lithium dose increases following this. 6,10…”

Section: Resultsmentioning

confidence: 99%

“…1 The risk of declining renal function or requirement of dialysis must also be balanced against the therapeutic benefits of lithium. 5,6…”

Section: Introductionmentioning

confidence: 99%

“…4 It is suggested that approximately 80% of lithium is removed from the extracellular fluid during a dialysis treatment. 6 Lithium slowly re-equilibrates back into the serum following dialysis, but ingestion of the next dose is required to achieve therapeutic serum concentrations following dialysis. 6 This re-distribution can cause a fluctuation in lithium concentrations known as a post-dialysis rebound.…”

Section: Introductionmentioning

confidence: 99%

“…6 Lithium slowly re-equilibrates back into the serum following dialysis, but ingestion of the next dose is required to achieve therapeutic serum concentrations following dialysis. 6 This re-distribution can cause a fluctuation in lithium concentrations known as a post-dialysis rebound. 4 The clearance of lithium has also been found to be inversely related to hematocrit, as lithium is not removed from erythrocytes during dialysis.…”

Section: Introductionmentioning

confidence: 99%

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Lithium therapy in patients on dialysis: A systematic review

McGrane

Omar

Morgan

et al. 2021

Int J Psychiatry Med

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Background Lithium is a first-line pharmacotherapy for the treatment of bipolar disorder, but long-term use is associated with nephrotoxicity. However, as dialysis effectively eliminates lithium, it remains a pharmacotherapeutic option for patients on dialysis. This systematic review seeks to evaluate the dosing, safety, efficacy, and monitoring of lithium in patients receiving dialysis. Method A PubMed database search performed May 5th, 2020, identified 535 article titles. After exclusion criteria were applied, a total of 15 articles were included in this systematic review. Results In 18 patients receiving dialysis, lithium was primarily used for the treatment of mood disorders. The majority of patients received 300–900 mg lithium carbonate thrice-weekly following dialysis, but several alternative lithium salts and dosing strategies were utilized. The pharmacokinetic properties of lithium in dialysis are not well understood and can be complicated by a serum lithium “rebound effect” following dialysis, due to a two-compartment volume of distribution. Additionally, presence of residual diuresis in some patients may be reason to administer lithium more frequently than thrice-weekly following dialysis. Lithium was shown to be an effective pharmacotherapy in all patients, with many demonstrating rapid improvement after drug initiation. Five patients experienced an adverse event on lithium, but only one patient required lithium discontinuation. Conclusion Lithium may be used in patients on dialysis, with close monitoring of pre-dialysis serum lithium concentrations for at least two weeks after treatment initiation, followed by a lower frequency after stabilization to ensure therapeutic concentrations and reduce toxicity risk.

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“…8,12 Three patients eventually underwent renal allograft and some required lithium dose increases following this. 6,10…”

Section: Resultsmentioning

confidence: 99%

“…1 The risk of declining renal function or requirement of dialysis must also be balanced against the therapeutic benefits of lithium. 5,6…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Lithium therapy in patients on dialysis: A systematic review

McGrane

Omar

Morgan

et al. 2021

Int J Psychiatry Med

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“…In the case discussed in this paper, the patient presented with a clear need to reconsider lithium in treating her bipolar disorder. Our medical hospital provided collaborative care for this complicated case and proved that lithium can still be considered for ESKD patients (2,16,17). There were no apparent medical or psychiatric benefits in stopping lithium treatment; rather, this aggravated her psychiatric condition.…”

Section: Discussionmentioning

confidence: 96%

Lithium Use in a Patient With Bipolar Disorder and End-Stage Kidney Disease on Hemodialysis: A Case Report

Chang

2020

Front. Psychiatry

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Lithium has been implicated in causing chronic tubulointerstitial nephritis and decline in renal function. However, lithium still plays a role in stabilizing patients with bipolar disorder. We illustrated a case of a bipolar I disorder patient approaching end-stage kidney disease (ESKD) with other medical comorbidities. As her mental state was affecting her compliance with medical treatment, she was mentally and medically unwell. Our patient was hospitalized on two separate occasions, for 5 and 4 months respectively, and failed adequate trials of different psychotropics due to inefficacy or intolerable side effects. A decision was made between the psychiatrist, nephrologist, and cardiologist to use lithium with hemodialysis support, with good treatment response and improved mental state. This case has shown that lithium carbonate can still be prescribed in ESKD patients on hemodialysis. Daily monitoring of lithium levels in the initial phase of lithium and hemodialysis commencement for at least 2 weeks is imperative, reducing to three times per week pre-hemodialysis towards the end of discharge after three consecutive daily serum lithium levels have stabilized. Clinicians can also consider a target serum level of less than 0.6 mEq/L in maintenance treatment for bipolar disorder in patients on hemodialysis.

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Pregnancy and Breastfeeding

2021

The Maudsley Prescribing Guidelines in Psychiatry

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Lifestyle factors have an important influence on pregnancy outcome. It is well established that smoking cigarettes, eating a poor diet and drinking alcohol during pregnancy can have adverse consequences for the foetus. The manufacturers of cariprazine have advised against its use in pregnancy because of an increased risk of malformations noted in animal studies. Women who take antidepressants during pregnancy may be at increased risk of developing hypertension, preeclampsia and postpartum haemorrhage. Lithium exposure during pregnancy has been associated with an increased risk of congenital anomalies. Anxiety disorders and insomnia are commonly seen in pregnancy. The long‐term benefits of breastfeeding on child physical health and cognitive development are well known. Discussions about the safety of drugs in breastfeeding should be held as early as possible ideally before conception or early in pregnancy. It is usually advisable to continue the antidepressant prescribed during pregnancy.

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Successful lithium treatment in a patient on hemodialysis

Cited by 8 publications

References 4 publications

Lithium therapy in patients on dialysis: A systematic review

Lithium therapy in patients on dialysis: A systematic review

Lithium Use in a Patient With Bipolar Disorder and End-Stage Kidney Disease on Hemodialysis: A Case Report

Pregnancy and Breastfeeding

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