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SGLT2 Inhibitors Associated With Improved Kidney Function in Lithium-Treated Patients With Mood Disorders: A
Mete Ercis1, Idil Tarikogullari1, Vanessa K Pazdernik2
1Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota, USA.
Introduction:
Sodium-glucose cotransporter-2 inhibitors (SGLT2i), initially developed for type 2 diabetes, have shown promise in improving renal outcomes in patients with and without diabetes. However, their effect on lithium-associated kidney dysfunction remains unknown.
Methods:
This historical cohort study included patients from Mayo Clinic (2001-2023) with mood disorders who received lithium for ≥ 6 months and later used SGLT2i for ≥ 1 month. Data on SGLT2i use and lithium treatment were extracted from electronic health records. Serum creatinine values were used to calculate estimated glomerular filtration rate (eGFR) trajectories. Linear mixed-effects models with piecewise linear splines were used to estimate eGFR slopes before and after SGLT2i initiation, adjusted for age and sex.
Results:
Fifty-six patients (mean age 57.4 years, 46.4% female), predominantly with bipolar disorder (87.5%), were included. The mean eGFR, measured nearest to SGLT2i initiation, was 77.9 ± 26.0 mL/min/1.73 m2, and the mean duration of SGLT2i use was 19.5 ± 17.8 months. Before SGLT2i initiation, eGFR declined at a rate of -1.43 mL/min/1.73 m2 per year (p < 0.001). After initiation, eGFR increased by 0.69 mL/min/1.73 m2 per year, reflecting a + 2.13 change (p = 0.025). Sensitivity analyses, including only patients on lithium at SGLT2i initiation (n = 22) or who had > 1 year of SGLT2i use (n = 29) showed similar, though non-significant, changes in slopes.
Conclusion:
SGLT2i treatment was associated with a significant improvement in eGFR trajectory in patients with mood disorders who received long-term lithium therapy. These findings suggest a potential role for SGLT2is in mitigating lithium-associated kidney dysfunction and highlight the need for randomized controlled trials in this population.
Insights
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improved kidney function in patients with mood disorders on lithium. This suggests SGLT2i may help prevent lithium-associated kidney damage.
Area of Science:
- Nephrology
- Psychiatry
- Pharmacology
Background:
- Sodium-glucose cotransporter-2 inhibitors (SGLT2i) show renal benefits in diabetic and non-diabetic patients.
- The impact of SGLT2i on lithium-associated kidney dysfunction is not well understood.
Purpose of the Study:
- To investigate the effect of SGLT2i on estimated glomerular filtration rate (eGFR) trajectories in patients with mood disorders receiving long-term lithium therapy.
Main Methods:
- Historical cohort study of 56 patients with mood disorders on lithium and later SGLT2i.
- Analysis of eGFR changes before and after SGLT2i initiation using linear mixed-effects models.
Main Results:
- Before SGLT2i, eGFR declined by -1.43 mL/min/1.73 m² per year.
- After SGLT2i initiation, eGFR increased by 0.69 mL/min/1.73 m² per year (p=0.025).
Conclusions:
- SGLT2i treatment was linked to improved eGFR trajectories in patients on long-term lithium.
- SGLT2i may mitigate lithium-induced kidney dysfunction, warranting further investigation via randomized controlled trials.
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