A decision analysis of long-term lithium treatment and the risk of renal failure

• Published in: Acta psychiatrica Scandinavica Vol. 126; no. 3; pp. 186 - 197
• Main Authors: Werneke, U., Ott, M., Renberg, E. Salander, Taylor, D., Stegmayr, B.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.09.2012; Blackwell
• Subjects: Adult and adolescent clinical studies; Affective disorders; Anticonvulsants; Antidepressive Agents - adverse effects; Antidepressive Agents - therapeutic use; Antimanic Agents - adverse effects; Antimanic Agents - therapeutic use; Biological and medical sciences; Bipolar disorder; Bipolar Disorder - drug therapy; Bipolar disorders; Decision analysis; Dose-Response Relationship, Drug; Drug therapy; End-stage renal disease; Humans; Kidney diseases; Kidney Failure, Chronic - chemically induced; Kidney Failure, Chronic - epidemiology; Kidney Function Tests; Literature reviews; Lithium; Lithium Carbonate - adverse effects; Lithium Carbonate - therapeutic use; Medical sciences; Mood disorders; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Neuropharmacology; Original; Pharmacology. Drug treatments; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychopharmacology; Renal failure; Secondary Prevention; Side effects; Suicide; Suicide - prevention & control; Suicide - statistics & numerical data; Time Factors; Treatment Outcome; Kidney disease; Mood disorder; Urinary system disease; Chronic renal failure; Psychotropic; Lithium; Bipolar disorder; Decision analysis; Suicide; end-stage renal disease; Long term; Treatment; Mood stabilizer; Risk factor; Renal failure
• ISSN: 0001-690X; 1600-0447; 1600-0447
• DOI: 10.1111/j.1600-0447.2012.01847.x

Werneke U, Ott M, Salander Renberg E, Taylor D, Stegmayr B. A decision analysis of long‐term lithium treatment and the risk of renal failure. Objective:  To establish whether lithium or anticonvulsant should be used for maintenance treatment for bipolar affective disorder (BPAD) if the risks of suicide and relapse were traded off against the risk of end‐stage renal disease (ESRD). Method:  Decision analysis based on a systematic literature review with two main decisions: (1) use of lithium or at treatment initiation and (2) the potential discontinuation of lithium in patients with chronic kidney disease (CKD) after 20 years of lithium treatment. The final endpoint was 30 years of treatment with five outcomes to consider: death from suicide, alive with stable or unstable BPAD, alive with or without ESRD. Results:  At the start of treatment, the model identified lithium as the treatment of choice. The risks of developing CKD or ESRD were not relevant at the starting point. Twenty years into treatment, lithium still remained treatment of choice. If CKD had occurred at this point, stopping lithium would only be an option if the likelihood of progression to ESRD exceeded 41.3% or if anticonvulsants always outperformed lithium regarding relapse prevention. Conclusion:  At the current state of knowledge, lithium initiation and continuation even in the presence of long‐term adverse renal effects should be recommended in most cases.