Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
Acta Psychiatr Scand. 2012 Sep;126(3):186-97. doi: 10.1111/j.1600-0447.2012.01847.x. Epub 2012 Mar 9.

A decision analysis of long-term lithium treatment and the risk of renal failure.

Author information

  • 1Division of Psychiatry, Department of Clinical Sciences, Umeå University, Sweden. uwerneke@gmail.com

Abstract

OBJECTIVE:

To establish whether lithium or anticonvulsant should be used for maintenance treatment for bipolar affective disorder (BPAD) if the risks of suicide and relapse were traded off against the risk of end-stage renal disease (ESRD).

METHOD:

Decision analysis based on a systematic literature review with two main decisions: (1) use of lithium or at treatment initiation and (2) the potential discontinuation of lithium in patients with chronic kidney disease (CKD) after 20 years of lithium treatment. The final endpoint was 30 years of treatment with five outcomes to consider: death from suicide, alive with stable or unstable BPAD, alive with or without ESRD.

RESULTS:

At the start of treatment, the model identified lithium as the treatment of choice. The risks of developing CKD or ESRD were not relevant at the starting point. Twenty years into treatment, lithium still remained treatment of choice. If CKD had occurred at this point, stopping lithium would only be an option if the likelihood of progression to ESRD exceeded 41.3% or if anticonvulsants always outperformed lithium regarding relapse prevention.

CONCLUSION:

At the current state of knowledge, lithium initiation and continuation even in the presence of long-term adverse renal effects should be recommended in most cases.

© 2012 John Wiley & Sons A/S.

PMID:
22404233
[PubMed - indexed for MEDLINE]
PMCID:
PMC3440572
Free PMC Article

Images from this publication.See all images (4)Free text

Fig. 1
Fig. 2
Fig. 3
Fig. 4
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Blackwell Publishing Icon for PubMed Central
    Loading ...
    Write to the Help Desk