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Published on: December 22, 2023
Cardiovascular comorbidity increases the risk for renal failure during prophylactic lithium treatment
Harald Aiff1, Per-Ola Attman2, Bernd Ramsauer3
1Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Insights
Somatic comorbidity, particularly cardiovascular disease, significantly increases the risk of kidney failure in patients undergoing long-term lithium treatment. Monitoring these conditions is crucial for patient safety and treatment recommendations.
Area of Science:
- Nephrology
- Psychiatry
- Cardiology
Background:
- Lithium is a cornerstone treatment for bipolar disorder, but its association with kidney damage remains debated.
- Investigating the influence of co-existing medical conditions on kidney function in lithium-treated patients is essential.
Purpose of the Study:
- To determine the role of somatic comorbidity in the development of kidney failure among patients receiving lithium therapy.
- To compare the prevalence of comorbidities between lithium-treated patients who developed severe renal failure and those who did not.
Main Methods:
- A retrospective study involving 1741 adult patients with normal baseline creatinine levels on lithium.
- Patients who developed severe renal failure (CKD stages 4-5) were matched with controls (CKD stages 1-2) based on sex, duration, and age at lithium initiation.
Main Results:
- No significant differences were observed in sex, duration of lithium treatment, or age at initiation between patients with severe renal failure and controls.
- A significantly higher prevalence of somatic comorbidity, especially cardiovascular diseases, was found in patients who developed severe renal failure (p < 0.001).
Conclusions:
- Somatic comorbidity, particularly cardiovascular comorbidity, plays a significant role in lithium-associated renal damage.
- Recommendations for long-term lithium treatment should incorporate monitoring of somatic comorbidity to enhance patient safety.
Background:
The development of lithium-associated kidney damage is still a matter of controversy. We have addressed this question by investigating the role of somatic comorbidity for developing kidney failure in lithium treated patients.
Methods:
The study group comprised of 1741 adult patients with normal creatinine levels at the start of lithium treatment. Patients who developed severe renal failure (CKD stages 4-5, n = 109), were matched by sex, time on lithium and age at start of lithium, with 109 controls (CKD stages 1-2) that did not develop severe renal failure.
Results:
Patients in CKD 4-5 did not differ significantly from controls (CKD 1-2) in sex (females/males were 76/33 in both groups), time on lithium (mean 9.8 years, SD 6.4; vs. 9.6, SD 6.2) or age at start of lithium (mean 61.6 years, SD 13.4; vs. 60.5 years, SD 12.3), respectively. However, comparisons between groups showed a significantly higher prevalence of somatic comorbidity (p < 0.001), especially cardiovascular diseases (p < 0.003), among patients in CKD 4-5.
Limitations:
Patients in our study group were relatively old and the findings are therefore not generalizable to patients starting lithium at an early age. The retrospective design, relying on available charts, did not allow to grade severity of comorbid conditions other than need for hospitalisation or chronic drug treatment.
Conclusions:
Our findings emphasize the role of somatic comorbidity for renal damage in lithium treated patients and especially the role of cardiovascular comorbidity. Monitoring of somatic comorbidity should be taken into account in treatment recommendations and safety routines in long-term prophylactic lithium treatment.
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