• P-ISSN 0973-7200 E-ISSN 2454-8405
  • Follow us

Journal of Pharmaceutical Research

Article

Journal of Pharmaceutical Research

Year: 2024, Volume: 23, Issue: 1, Pages: 49-54

Original Article

Evaluation of Kidney Function in Bipolar Patients: A Cross-Sectional Study

Abstract

Bipolar disorder is a chronic disease that represents a significant problem to the affected individual. To date, the mainstay treatment for bipolar disorder consists in mood stabilizers, mainly lithium, which have been linked to acute and chronic kidney injury. To investigate the association between Estimated Glomerular Filtration Rate (eGFR) and sociodemographic and clinical characteristics in a group of patients with bipolar disorder (BD) undergoing lithium treatment, with or without concomitant use of other psychopharmaceuticals. In this cross-sectional study data was collected using the instruments: 1 – Clinical and sociodemographic data questionnaire, developed by the Brazilian Consortium for Bipolar Disorder Research; 2 – Structured Clinical Interview for the DSM-IV Axis I Disorders; 3 – Hamilton’s Rating Scale for Depression, to evaluate depressive symptoms and 4 – Young’s Rating Scale for Mania to evaluate mania symptoms. Renal function was calculated through the CKD/EPI formula for eGFR. 95 patients were included in the final analysis. 26 (27.4%) patients presented reduction in eGFR, 21 (22,1%) with eGFR between 60 to 89 and 5 (5,2%) below 60. Higher serum lithium levels and age were associated with such reduction (β = -18.06 [95% CI: -34.70 to -1.42]); (β = -0.72 (95% CI: -1.10 to -0.33)), respectively. Although lithium is considered the “gold standard” in the treatment of BD, its toxicity and tolerability profile in relation to renal function still needs to be better understood. The results of this study reinforce the idea that periodic control of lithium levels is essential for preserving renal function. Long-term longitudinal studies are needed to assess the relationship between renal function and lithium therapy in BD patients.

Keywords

Lithium, Bipolar Disorder, Kidney, Renal Insufficiency

References

  1. Miller JN, Black DW. Bipolar Disorder and Suicide: A Review. Current Psychiatry Reports. 2020;22(2). Available from: https://doi.org/10.1007/s11920-020-1130-0
  2. Oliveira JLD, Júnior GBDS, Abreu KLSD, Rocha NDA, Franco LFLG, Araújo SMHA, et al. Nefrotoxicidade por lítio. Revista da Associação Médica Brasileira. 2010;56(5):600–606. Available from: https://www.scielo.br/j/ramb/a/Lgnbk9sJbYmFCZqRShsr6Rh/
  3. Baldessarini RJ, Tondo L, Vázquez GH. Pharmacological treatment of adult bipolar disorder. Molecular Psychiatry. 2019;24(2):198–217. Available from: https://doi.org/10.1038/s41380-018-0044-2
  4. Lage RR, Santana CMT, Nardi AE, Cheniaux E. Mixed states and suicidal behavior: a systematic review. Trends in Psychiatry and Psychotherapy. 2019;41(2):191–200. Available from: https://doi.org/10.1590/2237-6089-2018-0042
  5. Bendz H, Schön S, Attman POO, Aurell M. Renal failure occurs in chronic lithium treatment but is uncommon. Kidney International. 2010;77(3):219–224. Available from: https://doi.org/10.1038/ki.2009.433
  6. Boton R, Gaviria M, Batlle DC. Prevalence, Pathogenesis, and Treatment of Renal Dysfunction Associated With Chronic Lithium Therapy. American Journal of Kidney Diseases. 1987;10(5):329–345. Available from: https://pubmed.ncbi.nlm.nih.gov/3314489/
  7. Presne C, Fakhouri F, Noël LH, Stengel B, Even C, Kreis H, et al. Lithium-induced nephropathy: Rate of progression and prognostic factors. Kidney International. 2003;64(2):585–592. Available from: https://doi.org/10.1046/j.1523-1755.2003.00096.x
  8. Grünfeld JP, Rossier BC. Lithium nephrotoxicity revisited. Nat Rev Nephrol. 2009;5(5):270–276. Available from: https://pubmed.ncbi.nlm.nih.gov/19384328/
  9. Bocchetta A, Ardau R, Carta P, Ligas F, Sardu C, Pani A, et al. Duration of lithium treatment is a risk factor for reduced glomerular function: a cross-sectional study. BMC Medicine. 2013;11(1):33. Available from: https://doi.org/10.1186/1741-7015-11-33
  10. Fmedsci GMG, Geddes JR, Geddes JR, Mcknight RF, Adida M, Budge K. Lithium toxicity profi le: a systematic review and meta-analysis. Lancet [Internet]. 2012;379:721–770.
  11. Gitlin M. Lithium and the kidney. An updated review. Drug Saf. 1999;20(3):231–274. Available from: https://doi.org/10.2165/00002018-199920030-00004
  12. Christensen BM, Kim YHH, Kwon THH, Nielsen S. Lithium treatment induces a marked proliferation of primarily principal cells in rat kidney inner medullary collecting duct. American Journal of Physiology-Renal Physiology. 2006;291(1):F39–F48. Available from: https://doi.org/10.1152/ajprenal.00383.2005
  13. Ecelbarger CA. Lithium treatment and remodeling of the collecting duct. American Journal of Physiology-Renal Physiology. 2006;291(1):F37–F38. Available from: https://doi.org/10.1152/ajprenal.00046.2006
  14. Kortenoeven MLA, Schweer H, Cox R, Wetzels JFM, Deen PMT. Lithium reduces aquaporin-2 transcription independent of prostaglandins. American Journal of Physiology-Cell Physiology. 2012;302(1):C131–C140. Available from: https://doi.org/10.1152/ajpcell.00197.2011
  15. Volkmann C, Bschor T, Köhler S. Lithium Treatment Over the Lifespan. Frontiers in Psychiatry. Frontiers Media S.A. 2020;11. Available from: https://doi.org/10.3389/fpsyt.2020.00377
  16. Gitlin M. Lithium and the kidney. An updated review. Drug Saf. 1999;20(3):231–274.
  17. Levey AS, Stevens LA, Schmid CH, Zhang Y(, Castro AF, Feldman HI, et al. A New Equation to Estimate Glomerular Filtration Rate. Annals of Internal Medicine. 2009;150(9):604. Available from: https://doi.org/10.7326/0003-4819-150-9-200905050-00006
  18. Hommos MS, Glassock RJ, Rule AD. Structural and Functional Changes in Human Kidneys with Healthy Aging. Journal of the American Society of Nephrology. 2017;28(10):2838–2844. Available from: https://doi.org/10.1681/ASN.2017040421
  19. Tondo L, Abramowicz M, Alda M, Bauer MM, Bocchetta A, Bolzani L, et al. Long-term lithium treatment in bipolar disorder: effects on glomerular filtration rate and other metabolic parameters. International Journal of Bipolar Disorders. 2017;5(1). Available from: https://doi.org/10.1186/s40345-017-0096-2
  20. Mcknight RF, Adida M, Budge K, Stockton S, Goodwin GM, Geddes JR. Lithium toxicity profile: a systematic review and meta-analysis. The Lancet. 2012;379(9817):721–728. Available from: https://doi.org/10.1016/S0140-6736(11)61516-X
  21. Bocchetta A, Ardau R, Fanni T, Sardu C, Piras D, Pani A, et al. Renal function during long-term lithium treatment: a cross-sectional and longitudinal study. BMC Medicine. 2015;13(1):1–7. Available from: https://doi.org/10.1186/s12916-014-0249-4

Copyright

© 2024 Published by Krupanidhi College of Pharmacy. This is an open-access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/) 

DON'T MISS OUT!

Subscribe now for latest articles and news.