Managing bipolar affective disorder in chronic kidney disease when lithium is no longer an option

Area of Science:

• Nephrology
• Psychiatry
• Pharmacology

Background:

• Lithium therapy is a cornerstone treatment for bipolar affective disorder (BPAD).
• Long-term lithium use is associated with significant risks of chronic kidney disease (CKD) and end-stage renal disease (ESRD).
• Limited clinical guidance exists for managing BPAD patients with progressive kidney impairment on lithium.

Purpose of the Study:

• To report the clinical management and outcomes of two patients with BPAD experiencing lithium-induced kidney disease.
• To highlight the challenges in managing mental stability during lithium cessation due to renal decline.
• To explore potential therapeutic strategies, including concurrent lithium and hemodialysis.

Main Methods:

• Case report methodology detailing the clinical course of two patients with BPAD and declining renal function.
• Description of lithium cessation, subsequent mental health management, and renal replacement therapy.
• Evaluation of concurrent lithium and hemodialysis in one patient.

Main Results:

• Both patients experienced significant kidney function decline, progressing towards ESRD.
• Lithium cessation led to temporary mental instability in both cases.
• Concurrent lithium and hemodialysis was successfully implemented in one patient, maintaining mental stability.

Conclusions:

• Managing patients with BPAD on lithium therapy who develop progressive kidney disease presents complex clinical challenges.
• Careful monitoring and individualized treatment strategies are crucial to balance psychiatric stability and renal health.
• Concurrent lithium and hemodialysis may be a viable option for select patients nearing ESRD.