Van Alphen Arjan M, Bosch Tessa M, Kupka Ralph W, Hoekstra Rocco
Department of Nephrology, Maasstad Hospital, Rotterdam, The Netherlands.
Department of Hospital Pharmacy, Maasstad Hospital, Rotterdam, The Netherlands.
Int J Bipolar Disord. 2021 Jan 4;9(1):1. doi: 10.1186/s40345-020-00204-2.
Lithium-induced nephropathy is a known long-term complication, sometimes limiting the use of lithium as mood stabilizer. The aim of this study is to establish the incidence of chronic kidney disease and the rate of decline of renal function in patients using lithium and to identify risk factors.
We selected 1012 patients treated with lithium from the laboratory database of the Antes Centre for Mental Health Care spanning a period from 2000 to 2015. Serum lithium and creatinine concentrations were retrieved and eGFR was calculated using the 4-variable CKD-EPI formula. We calculated the incidence of renal insufficiency and the rate of decline. We compared patients with and without chronic kidney disease (CKD) stage 3 regarding duration of lithium exposure.
Incidence of chronic kidney disease was 0.012 cases per exposed patient-year. Average decline of eGFR was 1.8 ml/min/year in patients who developed chronic kidney disease stage 3. Incidence of chronic kidney disease stage 4 was only 0.0004 per patient year. No cases of end stage renal disease were found in this cohort. Odds of reaching chronic kidney disease stage 3 were increased with longer duration of lithium exposure.
The use of lithium seems to be related to a higher incidence of chronic kidney disease. Longer duration of lithium exposure significantly increased the risk of renal failure.
锂诱导的肾病是一种已知的长期并发症，有时会限制锂作为心境稳定剂的使用。本研究的目的是确定使用锂的患者中慢性肾脏病的发病率和肾功能下降率，并识别危险因素。
我们从安特斯精神卫生保健中心2000年至2015年的实验室数据库中选取了1012例接受锂治疗的患者。检索血清锂和肌酐浓度，并使用4变量CKD-EPI公式计算估算肾小球滤过率（eGFR）。我们计算了肾功能不全的发病率和下降率。比较了有和没有3期慢性肾脏病（CKD）的患者的锂暴露持续时间。
慢性肾脏病的发病率为每暴露患者年0.012例。发生3期慢性肾脏病的患者中，eGFR的平均下降速度为每年1.8毫升/分钟。4期慢性肾脏病的发病率仅为每年每患者0.0004例。该队列中未发现终末期肾病病例。锂暴露持续时间越长，达到3期慢性肾脏病的几率越高。
锂的使用似乎与慢性肾脏病的较高发病率有关。锂暴露持续时间越长，肾衰竭风险显著增加。
