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Related Experiment Video

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Kidney function decline improves after lithium discontinuation.

Filip Fransson¹, Ursula Werneke², Louise Öhlund²

¹Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.

Journal of Internal Medicine

|January 20, 2025

Summary

Stopping lithium treatment significantly slows kidney function decline, especially in patients with lower eGFR. Restarting lithium reverses this benefit, returning eGFR decline to previous levels.

Keywords:

bipolar disorder chronic kidney disease lithium renal function

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Area of Science:

Nephrology
Psychiatry
Pharmacology

Background:

Long-term lithium use is associated with decreased kidney function.
The impact of lithium cessation on renal function requires further investigation.

Purpose of the Study:

To evaluate kidney function changes in patients after discontinuing and subsequently restarting lithium therapy.
To assess the reversibility of lithium-induced nephrotoxicity.

Main Methods:

A mirror-image study design was employed using retrospective data from the LiSIE cohort.
Estimated glomerular filtration rate (eGFR) changes were analyzed over 5-year pre- and post-lithium discontinuation periods.
Covariates included sex, hypertension, and diabetes mellitus.

Main Results:

Discontinuation of lithium slowed the mean annual eGFR decline from -1.58 to -0.023 mL/min/1.73 m²/year (p < 0.0001).
The renal benefit was more pronounced in patients with lower baseline eGFR.
Restarting lithium led to an annual eGFR decline of -1.71 mL/min/1.73 m²/year, similar to pre-discontinuation rates.

Conclusions:

Lithium cessation significantly mitigates the decline in kidney function.
The positive effect on eGFR is more substantial in patients with pre-existing renal impairment.
Resumption of lithium therapy negates the protective effects on kidney function.