The Effect of Serum Lithium Levels on Renal Function in Geriatric Outpatients: A Retrospective Longitudinal Study
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Lithium remains an important treatment for bipolar disorder; however, whether elevated lithium levels lead to long-term renal problems is unknown. Previous consensus opinion was that levels should be kept below 0.6 mmol/L in geriatric patients to minimize renal toxicity.
We hypothesized that elevated serum lithium levels correlate with decreased renal function [estimated glomerular filtration rate (eGFR)] in geriatric psychiatry outpatients.
This was a 4-year retrospective cohort study (2007–2011).
We performed this study in three Canadian university-affiliated tertiary care clinics.
Data from 42 lithium-using geriatric psychiatry outpatients was used.
Our main exposure of interest was mean serum lithium level between 2007 and 2011.
Main outcome measure
Our primary outcome was change in eGFR between 2007 and 2011 (hypothesis formulated before data collection).
Lithium levels did not correlate significantly with change in eGFR at 2- or 4-year follow-up (r < 0.12, p > 0.57). There were no significant predictors of change in eGFR in a multiple linear regression model including hypertension, diabetes, baseline eGFR, lithium duration, and lithium levels.
Lithium levels do not correlate strongly (ρ > 0.5) with decreased eGFR at 2- and 4-year follow-up in geriatric outpatients. These results are not reliably generalizable when treating patients at mean lithium levels greater than 0.8 mEq/L, especially at 4-year follow-up, and larger studies will be necessary to examine the possibility of a smaller correlation. Nonetheless, these data and the existing literature suggest that lithium levels up to 0.8 mmol/L are safe for use in the long-term treatment of geriatric patients with mood disorders without pre-existing chronic renal failure.
- Yatham LN, Kennedy SH, O’Donovan C, Parikh S, MacQueen G, McIntyre R, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: consensus and controversies. Bipolar Disord. 2005;7(Suppl 3):5–69. CrossRef
- Hopkins HS, Gelenberg AJ. Serum lithium levels and the outcome of maintenance therapy of bipolar disorder. Bipolar Disord. 2000;2(3 Pt 1):174–9. CrossRef
- Al Jurdi RK, Marangell LB, Petersen NJ, Martinez M, Gyulai L, Sajatovic M. Prescription patterns of psychotropic medications in elderly compared with younger participants who achieved a “recovered” status in the systematic treatment enhancement program for bipolar disorder. Am J Geriatr Psychiatry. 2008;16(11):922–33. CrossRef
- Sproule BA, Hardy BG, Shulman KI. Differential pharmacokinetics of lithium in elderly patients. Drugs Aging. 2000;16(3):165–77. CrossRef
- Fahy S, Lawlor BA. Discontinuation of lithium augmentation in an elderly cohort. Int J Geriatr Psychiatry. 2001;16(10):1004–9. CrossRef
- Wilkinson D, Holmes C, Woolford J, Stammers S, North J. Prophylactic therapy with lithium in elderly patients with unipolar major depression. Int J Geriatr Psychiatry. 2002;17(7):619–22. CrossRef
- Hardy BG, Shulman KI, Zucchero C. Gradual discontinuation of lithium augmentation in elderly patients with unipolar depression. J Clin Psychopharmacol. 1997;17(1):22–6. CrossRef
- Shulman KI, Mackenzie S, Hardy B. The clinical use of lithium carbonate in old age: a review. Prog Neuropsychopharmacol Biol Psychiatry. 1987;11(2–3):159–64. CrossRef
- Boton R, Gaviria M, Batlle DC. Prevalence, pathogenesis, and treatment of renal dysfunction associated with chronic lithium therapy. Am J Kidney Dis. 1987;10(5):329–45.
- Bendz H, Schon S, Attman PO, Aurell M. Renal failure occurs in chronic lithium treatment but is uncommon. Kidney Int. 2010;77(3):219–24. CrossRef
- McKnight RF, Adida M, Budge K, Stockton S, Goodwin GM, Geddes JR. Lithium toxicity profile: a systematic review and meta-analysis. Lancet. 2012;379(9817):721–8. CrossRef
- Wells JE, Cross NB, Richardson AK. Toxicity profile of lithium. Lancet. 2012;379(9834):2338. CrossRef
- Rej S, Herrmann N, Shulman K. The effects of lithium on renal function in older adults–a systematic review. J Geriatr Psychiatry Neurol. 2012;25(1):51–61. CrossRef
- Lepkifker E, Sverdlik A, Iancu I, Ziv R, Segev S, Kotler M. Renal insufficiency in long-term lithium treatment. J Clin Psychiatry. 2004;65(6):850–6. CrossRef
- Crowe E, Halpin D, Stevens P. Early identification and management of chronic kidney disease: summary of NICE guidance. BMJ. 2008;29(337):a1530. doi:10.1136/bmj.a1530. CrossRef
- Rej S, Abitbol R, Looper K, Segal M. Chronic renal failure in lithium-using geriatric patients: effects of lithium continuation versus discontinuation—a 60-month retrospective study. Int J Geriatr Psychiatry. 2012. doi:10.1002/gps.3841.
- Malhi GS, Tanious M. Optimal frequency of lithium administration in the treatment of bipolar disorder: clinical and dosing considerations. CNS Drugs. 2011;25(4):289–98. CrossRef
- van Melick EJ, Meinders AE, Hoffman TO, Egberts TC. Renal effects of long-term lithium therapy in the elderly: a cross-sectional study. Int J Geriatr Psychiatry. 2008;23(7):685–92. CrossRef
- Paul R, Minay J, Cardwell C, Fogarty D, Kelly C. Meta-analysis of the effects of lithium usage on serum creatinine levels. J Psychopharmacol. 2010;24(10):1425–31. CrossRef
- Bendz H. Kidney function in a selected lithium population. A prospective, controlled, lithium-withdrawal study. Acta Psychiatr Scand. 1985;72(5):451–63. CrossRef
- Bendz H, Sjodin I, Aurell M. Renal function on and off lithium in patients treated with lithium for 15 years or more. A controlled, prospective lithium-withdrawal study. Nephrol Dial Transplant. 1996;11(3):457–60. CrossRef
- Presne C, Fakhouri F, Noel LH, Stengel B, Even C, Kreis H, et al. Lithium-induced nephropathy: rate of progression and prognostic factors. Kidney Int. 2003;64(2):585–92. CrossRef
- Hetmar O, Povlsen UJ, Ladefoged J, Bolwig TG. Lithium: long-term effects on the kidney. A prospective follow-up study ten years after kidney biopsy. Br J Psychiatry. 1991;158:53–8. CrossRef
- Bendz H, Aurell M, Balldin J, Mathe AA, Sjodin I. Kidney damage in long-term lithium patients: a cross-sectional study of patients with 15 years or more on lithium. Nephrol Dial Transplant. 1994;9(9):1250–4.
- Young RC, Schulberg HC, Gildengers AG, Sajatovic M, Mulsant BH, Gyulai L, et al. Conceptual and methodological issues in designing a randomized, controlled treatment trial for geriatric bipolar disorder: GERI-BD. Bipolar Disord. 2010;12(1):56–67. CrossRef
- Coresh J, Selvin E, Stevens LA, Manzi J, Kusek JW, Eggers P, et al. Prevalence of chronic kidney disease in the United States. JAMA. 2007;298(17):2038–47. CrossRef
- The Effect of Serum Lithium Levels on Renal Function in Geriatric Outpatients: A Retrospective Longitudinal Study
Drugs & Aging
Volume 30, Issue 6 , pp 409-415
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- 1. Department of Psychiatry, McGill University, Irving Ludmer Research and Training Building, 1033 Pine Avenue West, Montreal, H3A 1A1, Canada
- 2. Department of Psychiatry, Jewish General Hospital, Montreal, Canada
- 3. Division of Geriatric Psychiatry, Department of Psychiatry, Jewish General Hospital, Montreal, Canada