Information
Lithium Induced Chronic Kidney disease (CKD)
- Lithium is a life saving medication for those with bipolar affective disorder (BPAD) and as an adjuvant for depression.
- Renal side effects can include Nephrogenic Diabetes Insipidus (NDI) (approx. 15-30 %1) and a small proportion of patients will develop CKD
- NDI itself does not directly lead to progressive renal impairment 2.
- This renal impairment does not reverse with stopping or altering lithium dosing, and discontinuing could have detrimental outcomes for the patient’s mental health (and should always be made in conjunction with a senior psychiatrist who knows the patient well)
- The rate of CKD progression in this small proportion of patients is slow, with a very small progression to ESRD (absolute risk 0.5% 1 ) and therefore patients can be informed and prepared in adequate time.
- Major risk factors include: duration of lithium therapy and cumulative dosing 3
- It is worth considering that cardiovascular risk factors are also more prevalent in this population and so need to be appropriately addressed and may also contribute to CKD progression.
Who can refer:
GPs, AHPs, and Nurses, Hospital doctors.
Who to refer:
Please consider a referral to renal when the patients renal function has reached CKD stage 4 (eGFR 15-29), however individual cases may be appropriate for discussion by email or phone to the renal advice line (RIE.RenalAdvice@nhslothian.scot.nhs.uk) or if essential, the renal registrar on-call through switchboard.
How to refer:
Please refer to an outpatient CKD clinic (Sci Gateway: RIE – Renal Medicine – Basic Sign Referral), or as above for a specific question
Please remember to consider other causes of renal impairment, especially if the patient has high blood pressure, diabetes, abnormal urinalysis (the urine should be free of blood and protein), or if the rate of deterioration in renal function is high. These would need to be investigated further, and would need appropriate management as per the guidelines.
Renal function should routinely be checked every 6-12 months for a patient on lithium.
- McKnight RF et al. Lithium toxicity profile: a systematic review and meta-analysis. Lancet. 2012 Feb 25;379(9817):721-8. doi: 10.1016/S0140-6736(11)61516-X. Epub 2012 Jan 20. PMID: 22265699.
- Kripalani M, Shawcross J, Reilly J, Main J. Lithium and chronic kidney disease BMJ 2009; 339 :b2452 doi:10.1136/bmj.b2452
- https://www.uptodate.com/contents/renal-toxicity-of-lithium
