Bassilios Nader, Martel Patricia, Godard Valérie, Froissart Marc, Grünfeld Jean-Pierre, Stengel Bénédicte
Réseau Néphropar and Nephrology Department, AP-HP, Necker Hospital, Paris, France.
Nephrol Dial Transplant. 2008 Feb;23(2):562-5. doi: 10.1093/ndt/gfm567. Epub 2007 Nov 13.
The long-term risk of chronic kidney disease (CKD) in lithium (Li)-treated patients has been well established in the recent years.
We have evaluated GFR and serum calcium monitoring in 1179 Li-treated outpatients from an ambulatory laboratory database study. This has been performed in a single private laboratory in Paris from February 1997 to December 2004. Estimated GFR (eGFR) has been calculated using the abbreviated MDRD equation.
During an 8-year period, 695 patients (59%) had at least one serum creatinine measurement, whereas 484 had no creatinine measurement. The former group had also more frequent serum Li measurements. Mean serum lithium levels, were similar in both groups, 0.65 mmol/l vs 0.62 mmol/l. The percentage of patients with CKD stage 3 (eGFR 30-59 ml/min/1.73 m(2)) were 36%, 53%, 73% and 77%, and with CKD stage 4, 3%, 5%, 5%, 8% in patients aged 20-39, 40-59, 60-69, and > or = 70 years respectively. There was no significant rise in creatinine measurements (from 35% of the patients with at least one serum creatinine in 2003 to 39% in 2004; P = 0.66) despite intervention to intensify GFR monitoring by physicians. Serum calcium was tested at least once in 212 patients (18%) of whom 15 (7%) were found with hypercalcaemia.
A very high percentage of Li-treated outpatients have low eGFR. GFR monitoring is neglected in these patients, the majority of whom are no longer attending specialized clinics. Hypercalcaemia is less common but serum calcium monitoring is even more neglected. Ambulatory laboratory database surveillance provides a powerful means to contribute to CKD screening and monitoring.
近年来，锂盐治疗患者发生慢性肾脏病（CKD）的长期风险已得到充分证实。
我们通过一项门诊实验室数据库研究，对1179例接受锂盐治疗的门诊患者的肾小球滤过率（GFR）和血清钙监测情况进行了评估。研究于1997年2月至2004年12月在巴黎的一家私立实验室进行。采用简化的MDRD方程计算估算肾小球滤过率（eGFR）。
在8年期间，695例患者（59%）至少进行过一次血清肌酐测量，而484例患者未进行过肌酐测量。前一组患者的血清锂测量也更频繁。两组患者的平均血清锂水平相似，分别为0.65 mmol/L和0.62 mmol/L。20 - 39岁、40 - 59岁、60 - 69岁以及≥70岁患者中，CKD 3期（eGFR 30 - 59 ml/min/1.73 m²）的患者比例分别为36%、53%、73%和77%，CKD 4期的患者比例分别为3%、5%、5%、8%。尽管医生采取措施加强了GFR监测，但肌酐测量值并无显著上升（从2003年至少进行过一次血清肌酐测量的患者中的35%升至2004年的39%；P = 0.66）。212例患者（18%）至少进行过一次血清钙检测，其中15例（7%）被发现有高钙血症。
接受锂盐治疗的门诊患者中，eGFR降低的比例非常高。这些患者的GFR监测被忽视，其中大多数患者不再前往专科门诊就诊。高钙血症不太常见，但血清钙监测更是被忽视。门诊实验室数据库监测为CKD筛查和监测提供了有力手段。
