Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Department of Neurology, Mayo Clinic, Rochester, MN, USA.
Bipolar Disord. 2021 Nov;23(7):715-723. doi: 10.1111/bdi.13052. Epub 2021 Mar 11.
Long-term lithium therapy (LTLT) has been associated with kidney insufficiency in bipolar disorder (BD). We aimed to investigate the risk factors of chronic kidney disease (CKD) development and progression among BD patients receiving LTLT.
We included adult patients with BD on LTLT (≥1 year) who were enrolled in the Mayo Clinic Bipolar Biobank, Rochester, Minnesota. We reviewed electronic medical records to extract information related to lithium therapy and kidney-related data to assess changes in the estimated glomerular filtration rate (eGFR). CKD severity was assessed based on eGFR.
Among 154 patients who received LTLT, 41 patients (27%) developed CKD, of whom 20 (49%) patients continued lithium (continuers) and 19 (46%) discontinued it (discontinuers). The median time to stage 3 CKD development was 21.7 years from the start of Li treatment. Type-2 diabetes mellitus and benzodiazepine use were independent predictors for CKD development in the survival analysis, after controlling for age. The subsequent CKD progression rate did not differ between continuers and discontinuers (mean GFR 48.6 vs. 44.1, p = 0.13) at the end of follow-up duration (mean duration: 3.5 ± 4.4 years for continuers and 4.9 ± 5.3 years for discontinuers).
CKD was observed in one fourth of patients with BD receiving LTLT. There was no significant difference in the progression of CKD among Li continuers versus discontinuers, at the mean follow-up duration of 4.2 years, after the CKD diagnosis. Progression of CKD could be influenced by existing comorbidities and may not necessarily be due to lithium alone.
长期锂治疗（LTLT）与双相情感障碍（BD）患者的肾功能不全有关。我们旨在研究接受 LTLT 的 BD 患者发生慢性肾脏病（CKD）的风险因素及其进展。
我们纳入了在明尼苏达州罗切斯特市梅奥诊所双相情感障碍生物库接受 LTLT（≥1 年）的成年 BD 患者。我们查阅电子病历，提取与锂治疗和肾脏相关的数据，以评估肾小球滤过率（eGFR）的变化。根据 eGFR 评估 CKD 的严重程度。
在 154 名接受 LTLT 的患者中，41 名（27%）患者发生 CKD，其中 20 名（49%）患者继续锂治疗（持续组），19 名（46%）患者停止锂治疗（停药组）。从开始锂治疗到发展为 3 期 CKD 的中位时间为 21.7 年。在生存分析中，控制年龄后，2 型糖尿病和苯二氮䓬类药物的使用是 CKD 发生的独立预测因素。在随访结束时（持续组的平均随访时间为 3.5±4.4 年，停药组为 4.9±5.3 年），两组间 CKD 进展率无差异（持续组的平均肾小球滤过率为 48.6，停药组为 44.1，p=0.13）。
接受 LTLT 的 BD 患者中有四分之一出现 CKD。在 CKD 诊断后的平均 4.2 年随访中，锂持续组与停药组相比，CKD 进展无显著差异。CKD 的进展可能受现有合并症的影响，不一定是锂单独引起的。
