Rej Soham, Li Brian Weixi, Looper Karl, Segal Marilyn
a Department of Psychiatry , McGill University , Montreal , Canada.
Aging Ment Health. 2014 Sep;18(7):847-53. doi: 10.1080/13607863.2014.888536. Epub 2014 Feb 18.
Chronic renal failure is very common, affecting 30%-40% of community-dwelling elderly. We wished to verify whether geriatric psychiatry patients are at increased risk of renal dysfunction compared to elderly controls, as well as whether lithium exposure and other factors are important predictors of risk.
This is a four-year retrospective cohort and nested case-control study at a Canadian tertiary-care hospital using data from March 2007 to March 2011. We compared 82 geriatric psychiatry outpatients and 200 psychotropic-naïve family medicine controls aged ≥65. Our main continuous measure of renal outcome was change in estimated glomerular filtration rate (eGFR). Multivariate analyses were performed to determine potential risk factors for renal dysfunction in geriatric psychiatry patients, including age, hypertension, diabetes mellitus, diuretics, and lithium duration.
Clinically important decreases in eGFR (>8 mL/min/1.73 m(2)) were found in 40.2% of geriatric psychiatry patients compared to 29.5% of controls (p = 0.040). Multivariate analyses found that lithium duration was independently associated with adverse renal outcome in patients with eGFR < 60 mL/min/1.73 m(2). In this sub-population, lithium users had clinically important decreases in eGFR when compared to non-lithium users: 10.3 vs. 0.40 mL/min/1.73 m(2) (p = 0.017).
Geriatric psychiatry patients are at a greater risk for clinically important decreases of renal function than similarly aged controls. Lithium appears to be an important risk factor for renal dysfunction when eGFR is <60 mL/min/1.73 m(2). However, in the majority of older adults who have normal kidney function, lithium use appears to be safe.
慢性肾衰竭非常常见，影响30%-40%的社区老年居民。我们希望验证老年精神病患者与老年对照组相比，肾功能不全风险是否增加，以及锂暴露和其他因素是否为重要的风险预测因素。
这是一项在加拿大一家三级护理医院进行的为期四年的回顾性队列研究和巢式病例对照研究，使用2007年3月至2011年3月的数据。我们比较了82名老年精神病门诊患者和200名年龄≥65岁、未使用精神药物的家庭医学对照组。我们主要的肾脏结局连续测量指标是估计肾小球滤过率（eGFR）的变化。进行多变量分析以确定老年精神病患者肾功能不全的潜在风险因素，包括年龄、高血压、糖尿病、利尿剂和锂使用时长。
40.2%的老年精神病患者出现了具有临床意义的eGFR下降（>8 mL/min/1.73 m²），而对照组为29.5%（p = 0.040）。多变量分析发现，锂使用时长与eGFR<60 mL/min/1.73 m²的患者不良肾脏结局独立相关。在这一亚组人群中，与未使用锂的患者相比，使用锂的患者出现了具有临床意义的eGFR下降：10.3 vs. 0.40 mL/min/1.73 m²（p = 0.017）。
老年精神病患者比同龄对照组发生具有临床意义的肾功能下降的风险更高。当eGFR<60 mL/min/1.73 m²时，锂似乎是肾功能不全的一个重要风险因素。然而，在大多数肾功能正常的老年人中，使用锂似乎是安全的。
