[Renal complications of lithium use: to cease or to continue?]

Lithium is the most effective maintenance therapy for patients with bipolar disorder. Important renal adverse effects of chronic lithium use include nephrogenic diabetes insipidus (prevalence circa 20%) and chronic kidney disease (prevalence circa 10-20% after 5-9 years of lithium use). Chronic lithium use is linked with slowly progressive chronic kidney disease, though it rarely leads to end-stage renal failure (prevalence of 0.5-1.5%). It is currently not possible to predict which patients are susceptible to renal complications of lithium use. The most important risk factors for these renal adverse effects are age, duration of lithium use and chronic exposure to high lithium serum levels. It is unclear if discontinuation of lithium therapy is beneficial in patients with existing chronic kidney disease. As a result of a shared decision making process, in some patients continuation of lithium therapy may be an option despite existing lithium-induced renal complications. Future studies could investigate determinants of a good lithium response, possible predictors of lithium-induced renal adverse effects, and the effect of pharmacological interventions on lithium-induced renal complications.