Department of Psychiatry, Windsor House, Belfast City Hospital, Belfast.
Gen Hosp Psychiatry. 2013 Nov-Dec;35(6):631-5. doi: 10.1016/j.genhosppsych.2012.10.016. Epub 2013 Aug 13.
This study investigates the prevalence of lithium use, monitoring practice and associated effects on renal function in a large UK community sample.
A large population-based renal function database was cross-referenced with a general practitioner database of 404,673 patients. The renal function of patients prescribed lithium during the 2-year period was compared with that of matched controls. The renal monitoring patterns of these cases were investigated in a naturalistic observational study. Data underwent parametric testing - continuous variables by analysis of variance, with appropriate adjustment, and categorical outcomes by χ(2) testing. Block analysis of variance was undertaken on case-control data.
A total of 422 patients in the database were prescribed lithium. Renal function monitoring in accordance with published guidelines occurred in 69% of patients. Patients taking lithium had a significantly higher serum creatinine (5.8 μmol/L, P<.001) and lower glomerular filtration rate (5.9 ml/min, P<.001) when compared to matched controls.
This is the first study carried out in a large community sample. Lithium remains widely prescribed in the community setting. The study confirms that lithium has a statistically and clinically significant negative effect on renal function. Despite published guidelines and recognition of the importance of serial measurements, monitoring of renal function is inconsistent.
本研究调查了在一个大型英国社区样本中锂的使用情况、监测实践及其对肾功能的影响。
将一个大型基于人群的肾功能数据库与 404673 名患者的全科医生数据库进行交叉参考。将锂治疗期间的患者的肾功能与匹配的对照者的肾功能进行比较。对这些病例的肾脏监测模式进行了自然观察研究。数据接受了参数检验——连续变量通过方差分析进行，适当调整后进行分类结果的卡方检验。对病例对照数据进行了块方差分析。
数据库中共有 422 名患者接受了锂治疗。根据已发表的指南进行的肾功能监测在 69%的患者中发生。与匹配的对照者相比，服用锂的患者血清肌酐（5.8 μmol/L，P<.001）明显升高，肾小球滤过率（5.9 ml/min，P<.001）明显降低。
这是在大型社区样本中进行的第一项研究。锂仍在社区环境中广泛应用。该研究证实锂对肾功能具有统计学和临床意义的负面影响。尽管有已发表的指南和对连续测量重要性的认识，但肾功能监测仍不一致。
