Prediction of individuals at high risk of chronic kidney disease during treatment with lithium for bipolar disorder

1. Individuals with bipolar disorder at higher risk of chronic kidney disease after lithium initiation include patients who are young, female, obese, have high LDL cholesterol, and have lower baseline eGFR levels.

Evidence Rating Level: 2 (Good)

Lithium is the standard first-line treatment for bipolar disorder worldwide. However, due to its narrow therapeutic window and potential adverse effects, its use has waned. A rare adverse effect of lithium is irreversible kidney failure, with a prevalence of 0.23% compared to 0.11% for the general population. The current study created a model to classify individuals as high-risk or low-risk for developing chronic kidney disease (CKD) after initiation of lithium treatment. The study population consisted of patients aged 16 and over with a diagnosis of bipolar disorder for which lithium was prescribed, had a normal or close to normal kidney function at baseline, and had three estimated glomerular filtration rates (eGFRs) measured after lithium initiation. Patients were taken from two databases, 1609 from the Aurum database and 934 from the Gold database for external validation. For the Aurum cohort, 24.92% of patients developed stage 3a or greater CKD. Using eGFR trajectories to define the high-risk and low-risk group, 87.96% in the high-risk developed stage 3a or greater CKD, and 16.43% in the low-risk. 11.87% of the cohort was determined to be high-risk. The high-risk group was more likely to be younger, female, obese, have a high LDL cholesterol, and have a lower baseline eGFR. The same factors were found in the high-risk group for the Gold cohort. Overall, the study developed a model that classified around 10% of patients to be at higher risk of kidney injury after lithium initiation, which may have implications for alleviating concern around lithium use for patients identified as low-risk.

Click to read the study in BMC Medicine

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