Uncertainty prevailing about the role of lithium for the development of chronic renal failure; and the prevalence of lithium-induced end-stage renal disease (ESRD) being virtually unknown, we decided to clarify these issues.

Using a questionnaire we counted the number of former or present lithium patients among all ESRD patients on renal replacement therapy (RRT, i.e. dialysis or renal transplant) in two defined regions in Sweden, comprising 30 % of 9 million Swedes. We also counted the number of all lithium patients in the areas. A chart review is under way to retrieve clinical data for the assessment of the nephrotoxic effect of the lithium therapy.

There were 2,270 RRT patients (0.08 % of the general population). Twenty-seven of them (1.2 %) acknowledged long-term lithium treatment. Seventeen were on dialysis, ten were transplanted. The concurrent number of lithium patients was 3,567.

Based on our own earlier studies we estimate that 900 (25 %) of the lithium patients in the two regions had been on lithium ≥15 years. Thus, twenty-seven of the long-term lithium patients in this study were subject to RRT.

The prevalence of lithium nephropathy in the RRT population is at least 1 %, 0.8 % in the entire lithium population, and approximately 3 % among long-term lithium patients. The risk of developing ESRD is higher when on lithium therapy compared to the general population. Our results so far underscore the need for adequate safety programs, ascertaining the early detection of lithium nephropathy.