Boivin Elise, Le Daré Brendan, Bellay Romain, Vigneau Cécile, Mercerolle Marion, Bacle Astrid
Pôle Pharmacie, Service Hospitalo-Universitaire de Pharmacie, CHU Rennes, 35000, Rennes, France.
Institut NuMeCan (Nutrition, Metabolismes et Cancer), Réseau PREVITOX, INSERM, INRAE, Université de Rennes 1, Rennes, France.
Int J Bipolar Disord. 2023 Jan 29;11(1):4. doi: 10.1186/s40345-023-00286-8.
Lithium is well recognized as the first-line maintenance treatment for bipolar disorder (BD). However, besides therapeutic benefits attributed to lithium therapy, the associated side effects including endocrinological and renal disorders constitute important parameters in prescribing patterns and patient adherence. The objectives of this study is to (i) determine whether long-term lithium therapy is associated with a decrease in renal function, hyperparathyroidism and hypercalcemia and (ii) identify risk factors for lithium-induced chronic kidney disease (CKD).
We conducted a single-centered cohort study of adult patients (≥ 18 years) treated with lithium, who were enrolled at Rennes University Hospital in France between January 1, 2018 and June 1, 2020. Required data were collected from the patient's medical records: demographics characteristics (age, sex, body mass index), biologic parameters (GFR, lithium blood level, PTH and calcium), medical comorbidities (hypertension and diabetes), lithium treatment duration and dosage, and length of hospitalization.
A total of 248 patients were included (mean age: 60.2 ± 16.5 years). Duration of lithium treatment correlated with (i) deterioration of renal function estimated at - 2.9 mL/min/year (p < 0.0001) and (ii) the development of hyperparathyroidism (p < 0.01) and hypercalcemia (p < 0.01). We also noted that patients with lithium blood level > 0.8 mEq/mL had significantly lower GFR than patients with lithium blood level < 0.8 mEq/mL (61.8 mL/min versus 77.6 mL/min, respectively, p = 0.0134). Neither diabetes mellitus nor hypertension was associated with more rapid deterioration of renal function.
This study suggests that the duration of lithium treatment contribute to the deterioration of renal function, raising the question of reducing dosages in patients with a GFR < 60 mL/min. Overdoses has been identified as a risk factor for CKD, emphasizing the importance of regular re-evaluation of the lithium dose regimen. Also, long-term lithium therapy was associated with hyperparathyroidism and hypercalcemia. Particular vigilance is required on these points in order to limit the occurrence of endocrinological and renal lithium adverse effects.
锂盐被公认为双相情感障碍（BD）的一线维持治疗药物。然而，除了锂盐治疗带来的益处外，其相关副作用，包括内分泌和肾脏疾病，在处方模式和患者依从性方面构成了重要参数。本研究的目的是：（i）确定长期锂盐治疗是否与肾功能下降、甲状旁腺功能亢进和高钙血症有关；（ii）确定锂盐诱导的慢性肾脏病（CKD）的危险因素。
我们对2018年1月1日至2020年6月1日期间在法国雷恩大学医院接受锂盐治疗的成年患者（≥18岁）进行了单中心队列研究。所需数据从患者病历中收集：人口统计学特征（年龄、性别、体重指数）、生物学参数（肾小球滤过率、血锂水平、甲状旁腺激素和钙）、合并症（高血压和糖尿病）、锂盐治疗持续时间和剂量以及住院时间。
共纳入248例患者（平均年龄：60.2±16.5岁）。锂盐治疗持续时间与以下因素相关：（i）肾功能恶化，估计每年下降-2.9 mL/min（p<0.0001）；（ii）甲状旁腺功能亢进（p<0.01）和高钙血症（p<0.01）的发生。我们还注意到，血锂水平>0.8 mEq/mL的患者的肾小球滤过率显著低于血锂水平<0.8 mEq/mL的患者（分别为61.8 mL/min和77.6 mL/min，p = 0.0134）。糖尿病和高血压均与肾功能更快恶化无关。
本研究表明，锂盐治疗持续时间会导致肾功能恶化，这就提出了对于肾小球滤过率<60 mL/min的患者是否应减少剂量的问题。过量用药已被确定为慢性肾脏病的危险因素，强调了定期重新评估锂盐剂量方案的重要性。此外，长期锂盐治疗与甲状旁腺功能亢进和高钙血症有关。在这些方面需要特别警惕，以限制锂盐的内分泌和肾脏不良反应的发生。
