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Lithium: balancing mental and renal health

Research output: Contribution to journalComment/debatepeer-review

Original languageEnglish
Pages (from-to)760-761
Number of pages2
JournalThe Lancet Psychiatry
Volume9
Issue number10
Early online date15 Sep 2022
DOIs
Accepted/In press15 Aug 2022
E-pub ahead of print15 Sep 2022
PublishedOct 2022

Bibliographical note

Funding Information: RS reports grant support from the UK National Institute of Health and Care Research (NIHR), the German Research Foundation, and the European Commission; paid lectures (non-promotional) for Janssen and Lundbeck; and support for attending meetings from Janssen, the Royal College of Psychiatrists, the International Society of Bipolar Disorders, the International Society of Affective Disorders, the British Association for Psychopharmacology, and the Central European Biomedical Congress. AHY reports grant support as the chief or principal investigator from the NIHR and other public funding agencies, Janssen, Compass Pathways, Novartis, and LivaNova; consulting for Johnson & Johnson and Livanova; paid lectures and advisory boards for the following companies with drugs used in affective and related disorders: Lundbeck, Sunovion, Servier, Livanova, Janssen, Allegan, Bionomics, Sumitomo Dainippon Pharma, COMPASS, Sage, Novartis, and Neurocentrx; support for attending meetings from Lundbeck, Sunovion, Servier, Livanova, Janssen, Allegan, Bionomics, Sumitomo Dainippon Pharma, COMPASS, Sage, Novartis, and Neurocentrx; having a leadership or fiduciary role in the following boards: the International Society for Affective Disorders, the British Association for Psychopharmacology, the International College of Neuropsychopharmacology, the Drug Safety Research Unit, and Bipolar UK. AHY is an honorary consultant for South London and Maudsley National Health Service Trust. RS and AHY hold positions on journal editorial boards. This work is supported by the NIHR Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. The views expressed are those of the authors and not necessarily those of the NIHR or the UK Department of Health and Social Care. We are grateful to David Cousins for expert considerations surrounding low-dose lithium.

King's Authors

Abstract

In The Lancet Psychiatry, Filip Fransson and colleagues 1 have undertaken an in-depth examination of kidney function in people treated with lithium in two large representative cohorts in Sweden. 1 In more than 2200 participants, the authors compared individuals with bipolar disorder or schizoaffective disorder with the general population, finding that lithium was associated with steeper declines in estimated glomerular filtration rate (eGFR) and was found to contribute to chronic kidney disease. First, the authors found a steeper eGFR decline in patients than in controls, with this difference seemingly explained by lithium use. Lithium use was associated with an additional eGFR deterioration of 0·54mL/min/1·73m2 per year treated (R2=0·37). However, the effect of lithium on eGFR showed high interindividual variation, and this pattern was only significant for people taking lithium for more than 10 years. Of 22 chronic kidney disease cases, ten (45%) were definitively caused by lithium, with five (23%) partially attributable to lithium, and seven (32%) not attributable. Of cases not attributable to lithium, four (57%) had not been exposed to lithium, and two (67%) of the three who were exposed had lithium incorrectly recorded as the cause of chronic kidney disease on their medical records. Wrongful attribution of chronic kidney disease as being lithium induced is concerning, as this appears to occur routinely, albeit infrequently.

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