Kidney function in patients with bipolar disorder with and without lithium treatment

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Although it is known that lithium use is associated with nephrogenic diabetes insipidus in up to 87% of patients, the association between lithium use and chronic kidney disease is less certain.

The current study showed that long-term lithium use (i.e., 10 y) accelerated the decline in eGFR attributed to aging.

This was a cross-sectional cohort study.

Medical records were reviewed from patients enrolled in the Lithium-Study into Effects and Side-effects (LiSIE) and the Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA). The former cohort of patients (n=785; mean age = 49.8 y) were diagnosed with bipolar or schizoaffective disorder and prescribed lithium. The latter cohort of patients (n=1549; mean age = 51.9 y) were a representative sample of the general Swedish population.

The primary outcome was age-associated decline in the eGFR.

After adjustment for lithium use, the eGFR declined by 0.57 ml/min/1.73 m2/y in the LiSIE and MONICA cohorts.

Lithium use augmented the eGFR decline by 0.54 ml/min/1.73 m2/y; the steepest decline in eGFR occurred after 10 y of lithium use.

Lithium nephropathy was the most common cause of moderate-to-severe chronic kidney disease.