Lithium-Associated Kidney Failure: Predictors and Outcomes

Emily Qian; Kamal Sud; Vincent Lee

doi:10.1016/j.ekir.2024.01.047

Lithium-Associated Kidney Failure: Predictors and Outcomes

Kidney Int Rep. 2024 Feb 2;9(5):1276-1283. doi: 10.1016/j.ekir.2024.01.047. eCollection 2024 May.

Authors

Emily Qian¹, Kamal Sud^{2

3}, Vincent Lee^{4

5

6}

Affiliations

¹ Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
² Nepean Kidney Research Centre, Department of Renal Medicine, Nepean Hospital, Kingswood, New South Wales, Australia.
³ Faculty of Medicine and Health, Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
⁴ Department of Renal Medicine, Westmead Hospital, Sydney, New South Wales, Australia.
⁵ Westmead Applied Research Centre, The University of Sydney, Sydney, New South Wales, Australia.
⁶ Centre for Kidney Research, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.

Abstract

Introduction: Despite the widespread use of lithium for bipolar disorders and depression, little is known about the characteristics of patients with lithium-associated kidney failure receiving kidney replacement therapy (KRT).

Methods: We conducted a retrospective study using the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) to investigate the predictors and outcomes of patients with lithium-associated kidney failure receiving KRT.

Results: A total of 437 patients with lithium-associated kidney failure were compared to 1280 ANZDATA allocated controls of patients with kidney failure not associated with lithium. Patients with lithium-associated kidney failure commenced KRT at significantly older age (62 ± 10 vs. 58 ± 15 years; P < 0.001) and were more likely to be European (93% vs. 68%, P < 0.001), to be female (63% vs. 40%, P < 0.001), and to live in a postcode with a higher socioeconomic status (SES) (P < 0.001). In patients with lithium-associated kidney failure, there were lower rates of coronary artery disease (17% vs. 37%, P < 0.001), peripheral vascular disease (7% vs. 25%, P < 0.001), cerebrovascular disease (8% vs. 14%, P = 0.004) and diabetes mellitus (16% vs. 47%, P < 0.001). There were no differences between first KRT modality, although kidney transplantation and retransplantation rates were lower (21% vs. 27%, P = 0.008; 0.2% vs 3%, P = 0.001) with shorter wait-times to first transplantation (20 months vs. 29 months, P = 0.02) in the patients with lithium-associated kidney failure. Rates of at least 1 rejection episode was comparable (21% vs. 22%, P = 0.85) between the 2 groups. In addition, there were no survival differences regardless of KRT modality between the 2 groups.

Conclusion: Lithium-associated kidney failure represents a unique cohort which is predominantly older, female, European, with a higher SES and less comorbidities. Despite this, there are no differences in survival. Given the lower rate of transplantation, barriers to transplantation need further exploration.

Keywords: kidney replacement therapy; kidney transplantation; lithium nephrotoxicity; lithium-associated kidney failure; outcomes; predictors.