Kidney Week

Abstract: SA-PO1091

Changes in Kidney Function Associated with Discontinuation of Lithium Treatment

Session Information

• CKD: Epidemiology, Risk Factors, and Prevention - 3
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Gislason, Gisli, Landspitali, Reykjavik, Iceland

Gisli Gislason, MD

• Indridason, Olafur S., Landspitali, Reykjavik, Capital, Iceland

Olafur S. Indridason, MD, MS

• Sigurdsson, Engilbert, Landspitali, Reykjavik, Iceland

Engilbert Sigurdsson

• Palsson, Runolfur, Landspitali, Reykjavik, Iceland

Runolfur Palsson, MD, FASN

Background

Lithium treatment for mood disorders has been associated with a decrease in estimated glomerular filtration rate (eGFR) and the development of chronic kidney disease (CKD). It is not clear whether or to which degree discontinuation of lithium improves kidney function. This study examined changes in eGFR when lithium treatment is stopped.

Methods

This was a retrospective study of all persons in Iceland using lithium in the years 2003-2018 for whom serum creatinine (SCr) measurements were available more than a year after their last lithium exposure. Lithium exposure was defined as at least one lithium prescription or at least two serum lithium measurements with detectable levels. CKD stages 3-5 were defined according to the KDIGO GFR criteria. eGFR was calculated using the SCr-based CKD-EPI₂₀₀₉ equation. Mean eGFR was calculated for every individual in each year from five years before to five years after lithium discontinuation. Analysis of variance was used to assess the difference in eGFR between time periods.

Results

A total of 682 individuals had SCr measurements performed more than a year after lithium discontinuation, 81 of whom had developed CKD stage 3 or above before cessation of lithium treatment. For all individuals the mean eGFR declined from an initial level of 90.4±20.9 ml/min/1.73 m² five years before lithium discontinuation to 84.6±24.8 ml/min/1.73 m² in the year of lithium discontinuation (p=0.006), but remained stable in the ensuing years, concluding at 83.4±23.7 ml/min/1.73 m² five years after lithium was discontinued (p>0.1). In individuals with CKD stages 3-5 before lithium discontinuation, the mean eGFR was 63.5±19.6 ml/min/1.73 m² five years before discontinuation, 50.2±16.3 ml/min/1.73 m² at the time of discontinuation (p<0.001) and 48.6±21.0 ml/min/1.73 m² five years later (Figure).

Conclusion

Discontinuation of lithium therapy appears to stabilize the decline in kidney function and halt the progression of CKD.

Funding

• Government Support – Non-U.S.