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Kuiper WJ, Grootens KP, Kerckhoffs APM. Concurrent lithium and haemodialysis treatment: Clinical recommendations based on the literature and a multicentre survey. Bipolar Disord 2024; 26:335-347. [PMID: 37968245 DOI: 10.1111/bdi.13390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
INTRODUCTION Lithium has an irreplaceable role in the treatment of severe mood disorders, but declining renal function associated with its use leads to clinical dilemmas. Although not often applied, and requiring close monitoring and multidisciplinary actions, concurrent lithium and haemodialysis treatment (CLHT) is a feasible option. To our knowledge, however, there are no detailed consensus- or evidence-based treatment guidelines or directives on its delivery. METHODS To fill this gap, we reviewed the literature and surveyed psychiatrists and nephrologists with experience in CLHT using a self-designed questionnaire. Our goal was to form an integrated picture of the current knowledge and clinical practices of CLHT and formulate practical recommendations for colleagues being confronted with patients with renal dysfunction requiring lithium to help manage their mood disorder. RESULTS We identified 14 case reports and case series describing CLHT and one systematic review concluding CLHT to be effective. Ten nephrologists and six psychiatrists practising in the Netherlands completed our questionnaire, providing details on collaboration, lithium dosing regimens, serum level evaluations and additional amenities and services they deemed necessary during CLHT delivery. DISCUSSION We found that CLHT appears to be safe and effective and argue that delivery is a shared responsibility and needs continuous multidisciplinary finetuning. To facilitate delivery, we provide a flowchart for the initiation or reinstatement of lithium therapy in haemodialysis patients and a practical guide for CLHT, including an easy-to-use rule of thumb for calculating the lithium target dose.
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Affiliation(s)
- Wytse J Kuiper
- Department of Psychiatry, Pro Persona, Nijmegen, The Netherlands
- Department of Psychiatry, Reinier van Arkel, 's-Hertogenbosch, The Netherlands
| | - Koen P Grootens
- Department of Psychiatry, Reinier van Arkel, 's-Hertogenbosch, The Netherlands
- Tranzo, TSB, Tilburg University, Tilburg, The Netherlands
| | - Angèle P M Kerckhoffs
- Department of Nephrology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands
- Department of Geriatric Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
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Qian E, Sud K, Lee V. Lithium-Associated Kidney Failure: Predictors and Outcomes. Kidney Int Rep 2024; 9:1276-1283. [PMID: 38707830 PMCID: PMC11068970 DOI: 10.1016/j.ekir.2024.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/12/2024] [Accepted: 01/22/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Despite the widespread use of lithium for bipolar disorders and depression, little is known about the characteristics of patients with lithium-associated kidney failure receiving kidney replacement therapy (KRT). Methods We conducted a retrospective study using the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) to investigate the predictors and outcomes of patients with lithium-associated kidney failure receiving KRT. Results A total of 437 patients with lithium-associated kidney failure were compared to 1280 ANZDATA allocated controls of patients with kidney failure not associated with lithium. Patients with lithium-associated kidney failure commenced KRT at significantly older age (62 ± 10 vs. 58 ± 15 years; P < 0.001) and were more likely to be European (93% vs. 68%, P < 0.001), to be female (63% vs. 40%, P < 0.001), and to live in a postcode with a higher socioeconomic status (SES) (P < 0.001). In patients with lithium-associated kidney failure, there were lower rates of coronary artery disease (17% vs. 37%, P < 0.001), peripheral vascular disease (7% vs. 25%, P < 0.001), cerebrovascular disease (8% vs. 14%, P = 0.004) and diabetes mellitus (16% vs. 47%, P < 0.001). There were no differences between first KRT modality, although kidney transplantation and retransplantation rates were lower (21% vs. 27%, P = 0.008; 0.2% vs 3%, P = 0.001) with shorter wait-times to first transplantation (20 months vs. 29 months, P = 0.02) in the patients with lithium-associated kidney failure. Rates of at least 1 rejection episode was comparable (21% vs. 22%, P = 0.85) between the 2 groups. In addition, there were no survival differences regardless of KRT modality between the 2 groups. Conclusion Lithium-associated kidney failure represents a unique cohort which is predominantly older, female, European, with a higher SES and less comorbidities. Despite this, there are no differences in survival. Given the lower rate of transplantation, barriers to transplantation need further exploration.
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Affiliation(s)
- Emily Qian
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Kamal Sud
- Nepean Kidney Research Centre, Department of Renal Medicine, Nepean Hospital, Kingswood, New South Wales, Australia
- Faculty of Medicine and Health, Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Vincent Lee
- Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia
- Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Ferensztajn-Rochowiak E, Lewitzka U, Chłopocka-Woźniak M, Rybakowski JK. Effectiveness of ultra-long-term lithium treatment: relevant factors and case series. Int J Bipolar Disord 2024; 12:7. [PMID: 38489135 PMCID: PMC10942952 DOI: 10.1186/s40345-024-00328-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/18/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND The phenomenon of preventing the recurrences of mood disorders by the long-term lithium administration was discovered sixty years ago. Such a property of lithium has been unequivocally confirmed in subsequent years, and the procedure makes nowadays the gold standard for the pharmacological prophylaxis of bipolar disorder (BD). The efficacy of lithium prophylaxis surpasses other mood stabilizers, and the drug has the longest record as far as the duration of its administration is concerned. The continuation of lithium administration in case of good response could be a lifetime and last for several decades. The stability of lithium prophylactic efficacy in most patients is pretty steady. However, resuming lithium after its discontinuation may, in some patients, be less efficient. MAIN BODY In the article, the clinical and biological factors connected with the prophylactic efficacy of long-term lithium administration are listed. Next, the adverse and beneficial side effects of such longitudinal treatment are presented. The main problems of long-term lithium therapy, which could make an obstacle to lithium continuation, are connected with lithium's adverse effects on the kidney and, to lesser extent, on thyroid and parathyroid functions. In the paper, the management of these adversities is proposed. Finally, the case reports of three patients who have completed 50 years of lithium therapy are described. CONCLUSIONS The authors of the paper reckon that in the case of good response, lithium can be given indefinitely. Given the appropriate candidates for such therapy and successful management of the adverse effects, ultra-long term lithium therapy is possible and beneficial for such patients.
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Affiliation(s)
| | - Ute Lewitzka
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.
| | | | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
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Long-Term Lithium Therapy: Side Effects and Interactions. Pharmaceuticals (Basel) 2023; 16:ph16010074. [PMID: 36678571 PMCID: PMC9867198 DOI: 10.3390/ph16010074] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/20/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023] Open
Abstract
Lithium remains the drug of first choice for prophylactic treatment of bipolar disorder, preventing the recurrences of manic and depressive episodes. The longitudinal experiences with lithium administration greatly exceed those with other mood stabilizers. Among the adverse side effects of lithium, renal, gastrointestinal, neurological, thyroid, metabolic, cognitive, dermatological, cardiologic, and sexual are listed. Probably, the most important negative effect of lithium, occurring mostly after 10-20 years of its administration, is interstitial nephropathy. Beneficial side-effects of long-term lithium therapy also occur such as anti-suicidal, antiviral, and anti-dementia ones. Pharmacokinetic and pharmacodynamic interactions of lithium, mostly those with other drugs, may have an impact on the success of long-term lithium treatment. This paper makes the narrative updated review of lithium-induced side-effects and interactions that may influence its prophylactic effect in bipolar disorder. Their description, mechanisms, and management strategies are provided. The papers appearing in recent years focused mainly on the long-term lithium treatment are reviewed in detail, including recent research performed at Department of Psychiatry, Poznan University of Medical Sciences, Poland. Their own observations on ultra-long lithium treatment of patients with bipolar disorder are also presented. The review can help psychiatrists to perform a successful lithium prophylaxis in bipolar patients.
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Davis J, Desmond M, Berk M. Lithium and nephrotoxicity: a literature review of approaches to clinical management and risk stratification. BMC Nephrol 2018; 19:305. [PMID: 30390660 PMCID: PMC6215627 DOI: 10.1186/s12882-018-1101-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 10/12/2018] [Indexed: 11/30/2022] Open
Abstract
Background Despite lithium being the most efficacious treatment for bipolar disorder, its use has been decreasing at least in part due to concerns about its potential to cause significant nephrotoxicity. Whilst the ability of lithium to cause nephrogenic diabetes insipidus is well established, its ability to cause chronic kidney disease is a much more vexing issue, with various studies suggesting both positive and negative causality. Despite these differences, the weight of evidence suggests that lithium has the potential to cause end stage kidney disease, albeit over a prolonged period. Methods A search strategy for this review was developed to identify appropriate studies, sourced from the electronic databases EMBASE, PubMed (NLM) and MEDLINE. Search terms included lithium with the AND operator to combine with nephrotoxicity or nephropathy or chronic kidney disease or nephrogenic diabetes insipidus or renal and pathophysiology. Results The risks for the development of lithium induced nephropathy are less well defined but appear to include the length of duration of therapy as well as increasing age, as well as episodes of over dosage/elevated lithium levels. Whilst guidelines exist for the routine monitoring of lithium levels and renal function, it remains unclear when nephrological evaluation should occur, as well as when cessation of lithium therapy is appropriate balancing the significant attendant mental health risks as well as the potential for progression to occur despite cessation of therapy against the risks and morbidity of bipolar disorder itself. Conclusion This paper will elucidate on the current evidence pertaining to the topic of the clinical management of lithium induced nephrotoxicity and provide a guide for clinicians who are faced with the long-term management of these patients.
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Affiliation(s)
- J Davis
- Department of Renal Medicine, University Hospital Geelong, Rotary House, 325 Ryrie St, Geelong, VIC, Australia.
| | - M Desmond
- Department of Renal Medicine, University Hospital Geelong, Rotary House, 325 Ryrie St, Geelong, VIC, Australia
| | - M Berk
- IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, 75 Pigdons Road, Geelong, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, the Department of Psychiatry, and the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
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Beasley AK, Larson CC, Garcia-Pittman EC. Lithium rechallenge after renal transplant. Ment Health Clin 2017; 7:46-50. [PMID: 29955497 PMCID: PMC6007664 DOI: 10.9740/mhc.2017.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mrs B is a 65-year-old, married, white woman with long-standing history of bipolar disorder type I who achieved mood stability with chronic lithium treatment. She developed end-stage renal disease, which was suspected to be the result of chronic lithium exposure in the context of medical comorbidity, and subsequently required renal transplantation. Following transplantation and discontinuation of lithium, Mrs B was unable to achieve mood stability with multiple medication trials and required more than 40 medical and psychiatric hospitalizations with eventual transition to skilled nursing care. After much discussion among the psychiatric treatment team, the patient, and her husband, primary care provider, nephrologist, and renal transplant surgeon, the decision was made to restart the patient on lithium given her previous treatment success. The purpose of this case report is to discuss the use of lithium following renal transplantation. In this case, a multidisciplinary approach was used to assist the patient in carefully weighing the risks and benefits of her treatment decisions. The consensus of the patient, her husband, and her providers was that the benefit of mood stabilization outweighed the potential risks of renal toxicity. Although treatment with lithium after renal transplant is not a first-line treatment option, this case illustrates that lithium could be considered in certain cases.
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Affiliation(s)
- Anna K. Beasley
- (Corresponding author) Psychosomatic Medicine Fellow PGY-5, The University of Texas at Austin Dell Medical School, Austin, Texas
| | - Catherine C. Larson
- Child and Adolescent Psychiatry Fellow PGY-5, The University of Texas at Austin Dell Medical School, Austin, Texas
| | - Erica C. Garcia-Pittman
- Assistant Professor, The University of Texas at Austin Dell Medical School at Seton Family of Hospitals - Psychiatry Residency Program, Austin, Texas
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Butler MI, McCartan D, Cooney A, Kelly PO, Ahmed I, Little D, MacHale S, Conlon P. Outcomes of Renal Transplantation in Patients With Bipolar Affective Disorder and Schizophrenia: A National Retrospective Cohort Study. PSYCHOSOMATICS 2017; 58:69-76. [DOI: 10.1016/j.psym.2016.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 10/21/2022]
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