Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Sciences, University of Cagliari, Via Ospedale 54, Cagliari, 09124 Italy.
BMC Med. 2013 Feb 11;11:33. doi: 10.1186/1741-7015-11-33.
The adverse renal effects of lithium have long been known, but glomerular insufficiency had been considered an unlikely event until recently, when new studies have raised concern regarding very long-term treatment. In this cross-sectional study, we examined glomerular function in a cohort of patients treated with lithium for up to 33 years and a control group of lithium-naïve patients treated with other mood-stabilizers.
Patients with a diagnosis of recurrent or persistent affective disorders, examined between 1 October 2007 and 31 December 2009, were screened. Demographic and clinical data were extracted from clinical charts regarding two study groups: one for patients treated with lithium for at least 12 months and the other for patients never exposed to lithium. Multivariate regression analysis was applied: the dependent variable was the estimated glomerular filtration rate (eGFR) calculated from the last available serum creatinine value using the Modification of Diet in Renal Disease Study Group equation; the following independent variables, potentially associated with renal dysfunction, were included: gender, current age, duration of lithium treatment, cigarette smoking, hypertension, diabetes and dyslipidemia.
eGFRs lower than 60 ml/min were significantly more frequent in the group treated with lithium (38/139 = 27.3%) compared to lithium-naïve patients (4/70 = 5.7%) (P = 0.0002; Fisher's test). Regression analysis showed a significant effect on eGFR of age, gender and duration of lithium treatment but no effect of cigarette smoking, hypertension, diabetes or dyslipidemia. eGFR was estimated to decrease by 0.64 ml/min (95% confidence interval = 0.38 to 0.90; P = 0.00) for each year of lithium treatment.
The duration of lithium treatment is a risk factor for glomerular failure, in addition to advancing age. For example, all patients aged 60 years or older may be estimated to undergo Stage 3 or more severe chronic kidney disease (namely an eGFR less than 60 ml/min) if treated with lithium for 30 years. These data may be added to the current debate on the balance between the protective effects of lithium on recurrent affective disorders and suicide and the risk of renal disease.See related commentary article here http://www.biomedcentral.com/1741-7015/11/34.
锂的肾脏不良影响早已为人所知，但直到最近，新的研究对锂的长期治疗提出了担忧，人们才开始认为肾小球滤过功能不全不太可能发生。在这项横断面研究中，我们检查了接受锂治疗长达 33 年的患者队列和从未接受过锂治疗的其他心境稳定剂治疗的对照组的肾小球功能。
筛选 2007 年 10 月 1 日至 2009 年 12 月 31 日期间确诊的复发性或持续性情感障碍患者。从病历中提取有关两个研究组的人口统计学和临床数据：一组患者接受锂治疗至少 12 个月，另一组患者从未接受过锂治疗。应用多元回归分析：因变量为使用改良肾脏病饮食研究组方程从最后一次可用的血清肌酐值计算的估计肾小球滤过率（eGFR）；包括可能与肾功能障碍相关的以下独立变量：性别、当前年龄、锂治疗时间、吸烟、高血压、糖尿病和血脂异常。
与锂未治疗组（4/70=5.7%）相比，锂治疗组 eGFR 低于 60ml/min 的患者明显更多（38/139=27.3%）（P=0.0002；Fisher 检验）。回归分析显示，年龄、性别和锂治疗时间对 eGFR 有显著影响，但吸烟、高血压、糖尿病或血脂异常无影响。锂治疗每增加 1 年，eGFR 估计下降 0.64ml/min（95%置信区间：0.38-0.90；P=0.00）。
除了年龄增长外，锂治疗时间也是肾小球衰竭的一个危险因素。例如，如果所有 60 岁或以上的患者接受锂治疗 30 年，他们可能都被估计患有 3 期或更严重的慢性肾脏病（即 eGFR<60ml/min）。这些数据可能会加入关于锂对复发性情感障碍和自杀的保护作用与肾脏疾病风险之间平衡的当前争论。见此处的相关评论文章http://www.biomedcentral.com/1741-7015/11/34。
