Journal Article Annotations
2021, 4th Quarter
Annotations by Sahil Munjal, MD
In this systematic review, one-fourth of patients treated with lithium developed CKD Stages 3–5 after a long-term therapy duration (Primary outcome) with a pooled OR of 2.09 compared to the risk of CKD with a treatment other than lithium. In elderly patients, the prevalence of CKD increased up to one-third. The only significant moderator was the duration of lithium treatment with a trend being observed for cardiovascular disease.
Strength and weaknesses:
The review had wide inclusion criteria; nevertheless, majority of studies were rated high/fair using a scale for quality assessment. Sensitivity analyses were re-assuring and add internal validity. There was no evidence of publication bias. Substantial heterogeneity was seen across included studies due to their design. There was a risk of confounding due to polypharmacy of psychiatric/non-psychiatric drugs.
Lithium’s efficacy along with reported anti suicidal properties and neuroprotective effects makes it a mainstay in the treatment of bipolar disorder. Lithium has been consistently associated with significant renal impairment across multiple studies, even as this risk varies somewhat with multiple confounding variables and use of different measures. Though this review shows a twofold increased risk, but there is limited evidence to predict which patients on lithium therapy will develop CKD and thereby progress to ESRD. The study authors do highlight that lithium use should not be discouraged in bipolar patients. However, psychiatrists should regularly monitor renal function in patients with long duration of lithium treatment, especially who are elderly, have cardiovascular disease, and on the verge of developing CKD.