Renal outcomes in people with bipolar disorder treated with lithium: a retrospective cohort database study

Reilly, J.G.; Close, H.; Main, J.; Kripalani, M.; Hungin, P.; Wilson, D.; Mason, J.

Abstract

Background: Lithium is a key treatment for bipolar disorder and depression. Although its pathological renal effects influence prescribing and monitoring decisions, no largescale study has ever been conducted to quantify the risk of renal failure through lithium use, adjusted for other potential risk factors. Objectives: To determine the association between renal failure and lithium use among adults with bipolar disorder. Methods: This retrospective cohort study used the General Practice Research Database (GPRD) to access records of 6360 adults aged over 18 with a diagnosis of bipolar disorder from 01/01/1990–31/12/2007. The GPRD provides records for 6.4% of the UK population. Time-to-event analyses of renal outcomes were conducted in lithium users and non-users using Cox proportionate hazards models, adjusting hazard ratios for age, gender, co-morbidities, and polypharmacy. The primary outcome measure was renal failure. Results: Lithium users had a two-fold increased risk of renal failure (adjusted HR 2.05 (95% CI 1.29–3.27), a two and a half-fold increased risk of any chronic kidney disease (HR 2.41 (95% CI 1.96–2.96), and two-fold increase in allcause mortality (HR 2.19 (95% 1.93–2.49). Of the cohort, 2494 (39.21%) were lithium users; 417 (6.6%) had chronic kidney disease; and 77 (1.2%) had end-stage renal failure. Secondary analysis of dose adjusted exposure indicates an increased risk of renal failure as lithium exposure increases. Conclusions: Lithium therapy is associated with a two-fold increased risk of renal failure after adjustment for other predictors of kidney disease. Although absolute risk is small, this remains an important consideration in lithium prescribing, and questions arise about the effectiveness of current renal monitoring.

Citation

Reilly, J., Close, H., Main, J., Kripalani, M., Hungin, P., Wilson, D., & Mason, J. (2009). Renal outcomes in people with bipolar disorder treated with lithium: a retrospective cohort database study. Pharmacoepidemiology & Drug Safety, 18(S1), https://doi.org/10.1002/pds.1806

• Journal Article Type: Article
• Publication Date: Aug 1, 2009
• Deposit Date: Sep 29, 2010
• Journal: Pharmacoepidemiology and drug safety.
• Print ISSN: 1053-8569
• Electronic ISSN: 1099-1557
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 18
• Issue: S1
• DOI: https://doi.org/10.1002/pds.1806
• Public URL: https://durham-repository.worktribe.com/output/1539388