Rej Soham, Elie Dominique, Mucsi Istvan, Looper Karl J, Segal Marilyn
Division of Geriatric Psychiatry, Department of Psychiatry, University of Toronto, Toronto, ON, Canada,
Drugs Aging. 2015 Jan;32(1):31-42. doi: 10.1007/s40266-014-0234-9.
Lithium is an important medication in the treatment of mood disorders. However, clinicians are hesitant to use lithium in older adults for fear of its medical effects, particularly kidney disease. This review describes the current understanding of the epidemiology and mechanisms underlying chronic kidney disease (CKD) in older lithium users, with recommendations for using lithium safely in late life. Prevalence estimates of CKD in older lithium users range from 42-50%, which does not differ greatly from the 37.8% rates seen in community-dwelling non-lithium using, non-psychiatric populations. Clinical and pre-clinical data suggest a variety of synergistic mechanisms contributing to CKD in older lithium users, including aging, cardiovascular factors, oxidative stress, inflammation, nephrogenic diabetes insipidus, acute kidney injury, and medication interactions. With regards to CKD, lithium can be used safely in many older adults with mood disorders. Compared to patients with pre-existing CKD, those with an estimated glomerular filtration rate >60 mL/min/1.73 m(2) are probably not as susceptible to lithium-associated renal decline. Using lithium concentrations <0.8 mmol/L; monitoring lithium concentrations and renal function every 3-6 months; being vigilant about concurrent medication use (e.g., diuretics, anti-inflammatories); as well as preventing/treating acute kidney injury, nephrogenic diabetes insipidus, diabetes mellitus, hypertension, smoking, and coronary artery disease can all help prevent CKD and further renal decline in older lithium users.
锂是治疗情绪障碍的一种重要药物。然而，临床医生因担心其医学影响，尤其是肾脏疾病，而不愿在老年人中使用锂。这篇综述描述了目前对老年锂使用者慢性肾脏病（CKD）的流行病学及潜在机制的理解，并给出了在晚年安全使用锂的建议。老年锂使用者中CKD的患病率估计在42%至50%之间，与未使用锂的非精神病社区人群中37.8%的患病率相比，差异不大。临床和临床前数据表明，多种协同机制导致老年锂使用者发生CKD，包括衰老、心血管因素、氧化应激、炎症、肾性尿崩症、急性肾损伤和药物相互作用。关于CKD，许多患有情绪障碍的老年人可以安全使用锂。与已有CKD的患者相比，估计肾小球滤过率>60 mL/min/1.73 m²的患者可能对锂相关的肾脏功能衰退不太敏感。使用锂浓度<0.8 mmol/L；每3至6个月监测锂浓度和肾功能；警惕同时使用的药物（如利尿剂、抗炎药）；以及预防/治疗急性肾损伤、肾性尿崩症、糖尿病、高血压、吸烟和冠状动脉疾病，所有这些都有助于预防老年锂使用者的CKD及进一步的肾功能衰退。
