High Lithium Levels Adversely Affect Renal Function

A new study reveals that Lithium (Li), a mainstay treatment for patients with bipolar disorder, can cause acute kidney damage, even during a short-term exposure.

Researchers at the University of East Anglia (UEA; Norwich, United Kingdom) and the Norfolk and Suffolk NHS Foundation Trust (Norwich, United Kingdom) conducted a study involving 699 patients from the Norfolk-wide lithium register and database to determine associations between short-term exposure to elevated Li levels and estimated-glomerular filtration rate (eGFR) at 3, 6, and 12 months follow-up. The Li levels were 0.81–1.0, 1.01–1.2, and 1.21–2.0 mmol/L, with a reference group whose Li levels never exceeded 0.8 mmol/L.

The results showed that a single incident of a lithium level higher than 1 mmol/L was associated with a significant decrease in eGFR in the following 3 months, compared to patients whose Li levels never exceeded 0.8 mmol/L; kidney function remained affected for up to nine months after exposure to a high Li level. The researchers are currently exploring the effects of multiple exposures to high lithium levels on kidney function. The study was published on November 7, 2014, in BJM Open.

“A single exposure to a lithium level greater than 1.0 mmol/L is associated with an increased risk of kidney function impairment in the following three months and that the higher the level, the greater the effect,” said lead author Emma Kirkham, PhD, of UEA School of Pharmacy. “This highlights the need for regular monitoring undertaken at least every three months, and that monitoring should not be reduced further until the impact of more than one high-level of lithium has been fully established.”

Recently, the UK National Institute for Health and Care Excellence (NICE; London, United Kingdom) changed its recommendation that Li levels should be checked every six months, a reduction from the previous recommendation of checking Li levels every three months. The results of the study strongly support monitoring be undertaken at least every three months, in line with other guidelines, and not be reduced.

Related Links:
University of East Anglia
Norfolk and Suffolk NHS Foundation Trust
UK National Institute for Health and Care Excellence