Department of Psychiatry, Lund University Hospital, Lund, Sweden.
Kidney Int. 2010 Feb;77(3):219-24. doi: 10.1038/ki.2009.433. Epub 2009 Nov 25.
We sought to establish the prevalence of lithium-induced end-stage renal disease in two regions of Sweden with 2.7 million inhabitants corresponding to about 30% of the Swedish population. Eighteen patients with lithium-induced end-stage renal disease were identified among the 3369 patients in the general lithium-treated population, representing a sixfold increase in prevalence compared with the general population for renal replacement therapy. All lithium-treated patients were older than 46 years at end-stage renal disease with a mean lithium treatment time of 23 years with ten patients having discontinued lithium treatment an average of 10 years before the start of renal replacement therapy. The prevalence of chronic kidney disease (defined as plasma creatinine over 150 micromol/l) in the general lithium-treated population was about 1.2% (excluding patients on renal replacement therapy). Compared with lithium-treated patients without renal failure, those with chronic kidney disease were older and most were men but, as groups, their mean serum lithium levels and psychiatric diagnoses did not differ. We found that end-stage renal disease is an uncommon but not rare consequence of long-term lithium treatment and is more prevalent than previously thought. Time on lithium was the only identified risk factor in this study, suggesting that regular monitoring of renal function in these patients is mandatory.
我们试图在瑞典的两个地区确定锂诱导的终末期肾病的患病率，这两个地区有 270 万居民，约占瑞典人口的 30%。在接受一般锂治疗的 3369 名患者中，发现了 18 名锂诱导的终末期肾病患者，与一般人群接受肾脏替代治疗相比，患病率增加了六倍。所有锂治疗患者在终末期肾病时年龄均超过 46 岁，平均锂治疗时间为 23 年，其中 10 名患者在开始肾脏替代治疗前平均停止锂治疗 10 年。一般锂治疗人群中慢性肾脏病（定义为血浆肌酐超过 150 微摩尔/升）的患病率约为 1.2%（不包括接受肾脏替代治疗的患者）。与未发生肾衰竭的锂治疗患者相比，慢性肾脏病患者年龄更大，大多数为男性，但作为一个群体，他们的平均血清锂水平和精神科诊断并无差异。我们发现，终末期肾病是长期锂治疗的一种罕见但并非罕见的后果，其患病率高于以往认为的水平。在这项研究中，锂的使用时间是唯一确定的危险因素，这表明对这些患者的肾功能进行定期监测是强制性的。
