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Abstract: PO0188

Incidence of AKI in Individuals Treated with Lithium

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Gislason, Gisli, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
  • Indridason, Olafur S., Division of Nephrology, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
  • Sigurdsson, Engilbert, Mental Health Services, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
  • Palsson, Runolfur, Internal Medicine Services, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
Background

Lithium has been linked to acute kidney injury (AKI) at toxic blood levels but the risk of AKI has otherwise not been well studied. Interestingly, lithium has been shown to protect against tubular injury in experimental AKI models. The aim of the study was to examine the risk of AKI in individuals treated with lithium.

Methods

This was a retrospective cohort study of all individuals treated with lithium in Iceland in 2003–2018. A control group comprised patients with affective disorders (ICD 10 codes F30-F39) attending the outpatient clinic of the Mental Health Services at Landspitali–the National University Hospital in 2014–2016, who had never used lithium. Clinical and laboratory data, including ICD-9 and ICD-10 codes and serum creatinine (SCr) values, were obtained from nationwide electronic medical records. Individuals with <2 SCr values available were excluded. AKI was defined using the SCr component of the KDIGO criteria. Multivariable logistic regression was used for the analysis.

Results

The lithium-treated group consisted of 2682 individuals, of whom 2310 (86.1%) were included in the study. Of those, 297 (12.9%) developed AKI. Of 1426 individuals in the control group, 1218 (85.5%) were included and 97 (8.0%) developed AKI. Lithium use was not an independent risk factor for AKI (OR 0.93, 95% CI, 0.72–1.20; Table). When lithium users were analyzed separately, lithium intoxication (OR 2.34, 95% CI, 1.33–4.09), duration of lithium therapy (OR 1.01, 95% CI 1.00–1.01) and mean lithium concentration (OR 1.22, CI, 1.14–1.30) were all significant risk factors for development of AKI.

Conclusion

Our findings suggest that lithium use does not affect the incidence of AKI after controlling for important covariates. However, lithium intoxication, time on lithium therapy and blood lithium concentration are associated with increased risk of AKI.

Factors associated with AKI; multivariable logistic regression.
 Odds ratio95% confidence interval
Sex, women1.411.12 - 1.77
Age1.011.00 - 1.02
Initial eGFR0.980.98 - 0.99
Hypertension1.441.07 - 1.93
Cardiovascular disease1.230.95 - 1.58
Diabetes1.821.25 - 2.60
CKD0.940.68 - 1.32
Lithium use0.930.72 - 1.20

Funding

  • Government Support – Non-U.S.