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Lower Estimated Glomerular Filtration Rates in Patients On Long Term Lithium; a Comparative Study and a Meta-analysis of Literature

Published online by Cambridge University Press:  15 April 2020

C. Rodrigo ,
N.L. De Silva ,
R. Gunaratne ,
S. Rajapakse ,
V.A. De Silva  and
R. Hanwella
C. Rodrigo
Affiliation:
Clinical Medicine, Faculty of Medicine University of Colombo, Colombo, Sri Lanka
N.L. De Silva
Affiliation:
Clinical Medicine, Faculty of Medicine University of Colombo, Colombo, Sri Lanka
R. Gunaratne
Affiliation:
Clinical Medicine, Faculty of Medicine University of Colombo, Colombo, Sri Lanka
S. Rajapakse
Affiliation:
Clinical Medicine, Faculty of Medicine University of Colombo, Colombo, Sri Lanka
V.A. De Silva
Affiliation:
Psychological Medicine, Faculty of Medicine University of Colombo, Colombo, Sri Lanka
R. Hanwella
Affiliation:
Psychological Medicine, Faculty of Medicine University of Colombo, Colombo, Sri Lanka

Abstract

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Several studies have shown that long term lithium use is associated with a subtle decline in estimated glomerular filtration rate (eGFR). Lithium can be a risk factor for chronic kidney disease in long term users.

Objective

To compare eGFR values of patients on long term lithium compared to controls matched for age, sex and confounding comorbidities

Methods

Patients with bipolar affective disorder, who are on lithium (for at least a year), were compared against controls matched (1:1) for age, gender and presence or absence of diabetes and hypertension. The eGFR was calculated according to the modification of diet in renal disease study formula. A meta-analysis was performed to compare our findings with similar studies in literature.

Results

Forty seven patients met the inclusion criteria. They were matched with 47 controls. The eGFR values of lithium users were significantly low (p = 0.04) compared to controls and the mean decline in eGFR was -2.7 ml/min/1.73m2(SD ± 9.8) per year. The significant difference in eGFR persisted between the subgroup without comorbidities (diabetes and hypertension) and their controls but disappeared for subgroup with comorbidities and their controls. Nevertheless, lithium users had a lower eGFR in both subgroups. A meta-analysis of 9 studies showed a significant lowering in the glomerular filtration rate in lithium users compared to controls [mean difference -10.3 ml/min (95% confidence interval: -15.13 to -5.55, p < 0.0001).

Conclusions

Lithium causes a subtle decline in glomerular filtration rate and renal functions need to be monitored in lithium using patients.

Type
Article: 0545
Information
European Psychiatry , Volume 30 , Issue S1: Abstracts of the 23rd European Congress of Psychiatry , March 2015 , pp. 1
Copyright
Copyright © European Psychiatric Association 2015
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