The perspectives of patients with lithium-induced end-stage renal disease

Lithium is the treatment of choice for patients suffering from bipolar disorder (BD) but prolonged use induces renal dysfunction in at least 20% of patient. Intensive monitoring of kidney functioning helps to reveal early decline in renal failure. This study investigates the views and experiences of BD patients who have developed end-stage renal disease and were receiving renal replacement therapy.

The patients overall reported not to have been offered alternative treatment options at the start of lithium therapy or when renal functions deteriorated. All indicated to have lacked sound information and dialogue in accordance with shared decision making. Kidney monitoring was inadequate in many cases and decision making rushed.

Retrospectively, the treatment and monitoring of lithium and the information process were inadequate in many cases. We give suggestions on how to inform patients taking lithium for their BD timely and adequately on the course of renal function loss in the various stages of their treatment.