Country | Description | Primary finding | Data source | Number of subjects analyzed (N) | Reference |
---|---|---|---|---|---|
Denmark | Examine association between long-term lithium use (≥5 years) and risk of renal and upper urinary tract cancers | Not associated with an increased risk | Danish Cancer Registry between 2000 and 2012 | 6447 cases matched to 259,080 controls | Pottegard et al. 2016 |
Denmark | Compare rates of chronic kidney disease (CKD) and end-stage CKD in patients taking lithium or other drugs for BP | Maintenance treatment with lithium or anticonvulsants increases rate of CKD, but lithium is not associated with increased rate of end-stage CKD | Danish population registries 1994–2012 | 1,500,000 randomly selected controls, 26,731 exposed to lithium and 420,959 to anticonvulsants for any reason. 10,591 with primary diagnosis of BP | Kessing et al. 2015a |
Denmark | Assess risk of renal and upper urinary tract tumors among lithium users | Not associated with an increased risk | Danish population registries 1995–2012 | 1,500,000 randomly selected controls, 24,272 exposed to lithium and 386,255 to anticonvulsants for any reason. 9651 with primary diagnosis of BP | Kessing et al. 2015b |
Italy | Examined glomerular filtration rate (GFR) in patients with long-term lithium treatment | Lithium is a risk factor for reduced GFR. Renal dysfunction tends to appear after decades of treatment and to progress slowly. Median time to enter G3a was 25Â years | Lithium register from 1980 to 2012 | 953 patients. Patients treated up to 33Â years | Bocchetta et al. 2015 |
Scotland | Comparison of estimated glomerular filtration rate (eGFR) in patients recently started on lithium therapy versus those taking other medications for affective disorders | No effect of stable lithium maintenance therapy, with lithium levels in the therapeutic range, on rate of change in eGFR over time | Population of patients started on lithium therapy in Tayside between 2000 and 2011 | 305 in lithium group; 815 in comparator group. Mean duration of exposure 55Â months | Clos et al. 2015 |
Sweden | Determine prevalence and extent of kidney damage during course of long-term lithium treatment | About one-third of patients treated for ≥10 years had evidence of chronic renal failure; only 5 % severe. Continuous monitoring of kidney function is required | Lab data from all Gothenburg area public hospitals and clinics | 630 patients starting lithium after 1980 with ≥10 years of cumulative lithium treatment | Aiff et al. 2015 |
UK | Compared lab measures of renal, thyroid and parathyroid function in those with at least two lithium measurements versus those with no lithium measurements | Lithium treatment associated with decline in renal function, hypothyroidism and hypercalcemia. Women <60 years with lithium concentrations higher than median at greatest risk. Long-term monitoring needed | Lab data from Oxfordshire area between 1985 and 2014 | 2795 ≥18 years with at least two lithium measurements; 689,228 controls | Shine et al. 2015 |
UK | Assess association between lithium use and renal failure in patients with bipolar disorder | Ever use of lithium was associated with an increased risk of renal failure (adjusted hazard ratio 2.5). Absolute risk of renal failure was age dependent and small | General practice research database from 418 practices between 1990 and 2007 | 6360 with BP; 2496 lithium users; 3864 non-users | Close et al. 2014 |
US | Possibility of stratifying risk for renal insufficiency among lithium treated patients | Use of lithium more than once daily; lithium levels >0.6 mEq/l, and use of first generation AP independently associated with risk | EMR records from large healthcare system 2006–2013 | 1445 lithium users with renal insufficiency; 4306 lithium users for comparison | Castro et al. 2015b |