Key result
High baseline creatinine before lithium initiation is linked to greater risk of CKD 4-5.
Why the study?
Little is known about the risks of developing severe renal impairment in patients starting lithium treatment with already compromised renal function.
Does starting lithium treatment in patients with compromised renal function increase the risk of developing severe renal impairment compared to patients with normal renal function?
Cohort (n=166)
No
Does starting lithium treatment in patients with compromised renal function increase the risk of developing severe renal impairment compared to patients with normal renal function?
Starting lithium in patients with pre-existing renal impairment significantly increases the risk of progression to severe CKD, highlighting the need for careful monitoring, especially in older patients with cardiovascular comorbidities.
Answers are grounded in this paper and cite their sources.
Pre-lithium renal impairment was associated with higher CKD progression risk; leaves open whether to avoid initiation in such patients.
BACKGROUND: Little is known of the risks involved for patients who, at the start of lithium treatment, already have compromised renal function. AIMS: To assess the risk of developing severe renal impairment (chronic kidney disease (CKD) 4-5) among those patients and to explore predictors for the progression. METHODS: A retrospective longitudinal cohort study using data from Sahlgrenska University Hospital's laboratory database 1981-2017. We compared the risk of developing CKD 4-5 in two patient cohorts: an exposed cohort of 83 patients who had high serum creatinine prior to start of lithium and a reference cohort of 83 patients with normal serum creatinine, matched by gender, duration of lithium treatment and age at the start of lithium treatment. The patients' medical charts were reviewed and the Swedish Renal Registry was used to identify patients with renal replacement therapy. The progressors were older at the start of lithium treatment and were characterised by a higher burden of comorbid somatic diseases, in particular cardiovascular diseases. CONCLUSIONS: Compromised renal function prior to initiating lithium treatment increases the risk of developing severe renal impairment. Monitoring of renal function should include somatic comorbidity among older patients.
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Golic et al. (2020) conducted a cohort in Lithium treatment (n=166). High serum creatinine prior to lithium treatment vs. Normal serum creatinine was evaluated on Development of severe renal impairment (CKD 4-5) (p=<0.001). High serum creatinine prior to initiating lithium treatment increased the risk of developing severe renal impairment (CKD 4-5) over a mean follow-up of >10 years.
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