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Abstract: FR-PO099

Risk of AKI During Treatment With Lithium

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Gislason, Gisli, Haskoli Islands, 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, Division of Nephrology, Landspitali–The National University Hospital of Iceland, Reykjavik, Iceland
Background

Lithium intoxication is frequently associated with acute kidney injury (AKI), but the risk of AKI has otherwise not been well studied in persons using lithium. The aim of the study was to examine the risk of AKI in individuals on lithium treatment.

Methods

This was a retrospective cohort study of all persons treated with lithium in Iceland in 2003–2018. A control group comprised patients with affective disorders attending the outpatient clinic of the Mental Health Services at Landspitali–The National University Hospital in 2014–2016. Clinical and laboratory data were obtained from nationwide electronic medical records. Individuals with <2 serum creatinine (SCr) values were excluded. Lithium exposure was defined as two or more measurable serum lithium levels or one or more filled lithium prescription. Individuals were censored at the time of last lithium exposure. AKI was defined using the SCr component of the KDIGO criteria. Risk assessment was performed using Cox proportional hazards with time-dependent variables.

Results

The lithium-treated group consisted of 2682 individuals, of whom 2017 (74.5%) were included in the study. Of those, 283 (14.0%) developed AKI. Of 1426 individuals in the control group, 1165 (81.8%) were included in the study and 48 (4.1%) of those developed AKI. Lithium use was an independent risk factor for AKI (hazard ratio [HR] 3.01, 95% confidence interval [CI], 2.25–4.23). When lithium users were analyzed separately, history of lithium toxicity (HR 2.87, 95% CI, 1.87–4.40) and higher mean lithium concentration (HR 1.15 per 0.1 mEq/L, 95% CI, 1.07–1.24,) were significant risk factors for the development of AKI.

Conclusion

Lithium treatment is associated with a risk of AKI. History of lithium toxicity and higher blood lithium concentrations seem to contribute to AKI in lithium users. Lithium levels should be followed carefully in these patients and be maintained at lowest possible levels that meet their therapeutic needs at any given time.

Funding

  • Government Support – Non-U.S.