Lithium and Kidney Disease: Good News or Bad News?

Steven Dubovsky, MD reviewing Kessing LV et al. JAMA Psychiatry 2015 Nov 4. Goodwin GM. JAMA Psychiatry 2015 Nov 4.

A new study finds increased risk for chronic kidney disease, but not for end-stage disease.

It hasn't been definitively established whether lithium increases the risk for chronic kidney disease (CKD). Danish investigators used national databases to examine the relationship between diagnosis, medication use, and CKD in 1.8 million people from 1995 to 2012. End-stage CKD (requiring dialysis or transplant) was diagnosed in 0.2% of the sample, possible CKD in 1.0%, and definite CKD in 0.8%.

The risk for all kinds of CKD was highest in people with a bipolar diagnosis, independent of all medications. In the 10,591 people with a first inpatient or outpatient psychiatric contact and a diagnosis of mania or bipolar disorder during the study period, risks for definite and possible CKD significantly increased, by a similar magnitude, with the number of prescriptions for lithium or anticonvulsants. Risk for end-stage CKD did not increase significantly with the number of lithium prescriptions, but did increase significantly with the number of anticonvulsant prescriptions. Antipsychotic drugs and antidepressants did not increase risk.

Citation(s):

Kessing LV et al. Use of lithium and anticonvulsants and the rate of chronic kidney disease: A nationwide population-based study. JAMA Psychiatry 2015 Nov 4; [e-pub].

Goodwin GM.The safety of lithium. JAMA Psychiatry 2015 Nov 4; [e-pub].