Lithium increases risk of renal decline in older patients
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Lithium increases risk of renal decline in older patients Lithium use appears to increase the risk of renal dysfunction and progressive renal decline in older patients, according to findings of a Canadian cohort study published in the Journal of Clinical Psychiatry. Data from linked administrative healthcare databases at the Institute for Clinical and Evaluative Sciences in adults over 65 years of age with bipolar disorder or depression in Ontario, Canada, who received two prescriptions of lithium or valproic acid [valproate] between 2007 and 2015 were used to investigate the risk of renal decline (≥ 30% reduction in estimated glomerular filtration rate from baseline) in 3113 lithium users versus 3113 propensity score-matched valproic acid users, over a median follow-up duration of 3 years. Overall, lithium significantly increased the risk of renal decline compared with valproic acid (6.5 vs 5.7 events per 100 patient-years; hazard ratio [HR] 1.14; 95% CI 1.02, 1.27). The risk of renal decline was significantly greater with lithium versus valproic acid in patients with baseline serum lithium concentrations above 0.7 mmol/L (HR 1.26; 95% CI 1.06, 1.49) but not in those with serum lithium concentrations of 0.7 mmol/L or lower (HR 1.06; 95% CI 0.92, 1.22). "In older adults, lithium use is associated with a statistically significant, but modest, increased risk of progressive renal decline," concluded the authors. "Further research could . . . assess whether changing laboratory recommendations for geriatric lithium levels to ≤ 0.7 mmol/L and the use of centralized monitoring/warning systems could still be effective psychiatrically, while preventing renal disease in lithium users," they suggested. Rej S, et al. Association of Lithium Use and a Higher Serum Concentration of Lithium With the Risk of Declining Renal Function in Older Adults: A Population-Based 803500435 Cohort Study. Journal of Clinical Psychiatry 81: No. 5, 18 Aug 2020. Available from: URL: http://doi.org/10.4088/JCP.19m13045
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Reactions 12 Sep 2020 No. 1821
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