Kidney Week

Abstract: SA-OR30

The Risk of CKD in Lithium-Treated Individuals

Session Information

• Epidemiology of CKD Progression: Who, Why, and When?
  November 04, 2023 | Location: Room 119, Pennsylvania Convention Center
  Abstract Time: 04:48 PM - 04:57 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Gislason, Gisli, Heilbrigdisvisindasvid - Haskoli Island, Reykjavik, Iceland

Gisli Gislason, MD

• Indridason, Olafur S., Landspitali, Reykjavik, Capital, Iceland

Olafur S. Indridason,

• Sigurdsson, Engilbert, Heilbrigdisvisindasvid - Haskoli Island, Reykjavik, Iceland

Engilbert Sigurdsson,

• Palsson, Runolfur, Heilbrigdisvisindasvid - Haskoli Island, Reykjavik, Iceland

Runolfur Palsson,

Background

The use of lithium may contribute to chronic kidney disease (CKD) but studies have yielded conflicting results. The aim of this study was to examine the risk of developing CKD stage 3 and above among persons treated with lithium.

Methods

This was a retrospective cohort study of all persons in Iceland using lithium in the years 2008-2018. Patients with affective disorders (ICD-10 codes F30-F39) attending the outpatient clinics of the Landspitali–The National University Hospital Mental Health Services in 2014-2016 who had not been prescribed lithium served as controls. CKD stages 3-5 was defined as eGFR <60 ml/min/1.73 m²,eGFR was calculated using the serum creatinine (SCr) based CKD-EPI equation. Individuals with fewer than 2 SCr measurements during the study period and those with CKD stages 3-5 prior to 2008 were excluded. Cox regression was performed to assess the risk of CKD associated with lithium treatment in a time dependent manner, adjusting for important confounding factors where acute kidney injury (AKI), hypertension, diabetes mellitus (DM) and cardiovascular diseases were treated as time-dependent covariates.

Results

A total of 2760 persons received lithium treatment during the study period, of whom 2046 (74.1%) were included in the study. Of those, 221 (10.9%) developed CKD stages 3-5. Of the 1615 persons in the control group, 1220 (75.6%) were included, of whom 39 (3.2%) developed CKD 3-5. Lithium use was associated with incident CKD (hazard ratio [HR] 1.93, 95% confidence interval [CI] 1.37–2.74) in the adjusted model. Age per year (HR 1.03, 95% CI 1.02–1.04), initial eGFR per mL/min/1.73 m² (HR 0.92-0.96, 95% CI 0.92–0.99), DM (HR 1.73, 95% CI 1.15–2.48) and AKI (HR 1.89, 95% CI 1.32–2.74) were other significant CKD risk factors. When compared to individuals not exposed to lithium the HR for CKD in adjusted analysis was 1.24 (95% CI 0.81–1.89) for those with mean lithium concentration of 0.3-0.59 mmol/L, 2.88 (95% CI 1.97–4.20) for those with mean lithium concentration of 0.6-0.79 mmol/L, and 5.23 (95% CI 3.31-8.26) for those with mean lithium concentration of 0.8-0.99 mmol/L.

Conclusion

Long-term lithium use is associated with risk of CKD in a concentration-dependent manner among patients with bipolar and unipolar mood disorders. Therefore, the mean blood concentration of lithium should be kept as low as possible for adequate mood stabilization and treatment.

Funding

• Government Support – Non-U.S.