ArticleBMC medicine2021
Prediction of individuals at high risk of chronic kidney disease during treatment with lithium for bipolar disorder.
Article in BMC medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 22 citations in OpenAlex.
- Psychotropic Drugs and Adverse Kidney Effects: A Systematic Review of the Past Decade of Research.CNS drugs · 2022Pooled it
- A Significant Decline of Glomerular Filtration Rate in the Majority of Long-Term Lithium Users: Results of a Dutch Prospective 10-Year Cohort Study.Bipolar disorders · 2026Article
- Lithium nephrotoxicity: a systematic review and meta-analysis of lithium versus non-lithium control studies in patients with affective disorders.Therapeutic advances in psychopharmacology · 2026Review
- Prevalence of Severe Mental Illness and Its Associations With Health Outcomes in Patients With CKD: A Swedish Nationwide Study.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2025Article
- Lithium and Kidney Disease.Mayo Clinic proceedings · 2025Article
- Review
- Lithium-Associated Kidney Failure: Predictors and Outcomes.Kidney international reports · 2024Article
- Key questions on the long term renal effects of lithium: a review of pertinent data.International journal of bipolar disorders · 2023Review
- Development and Validation of a Prediction Model for Future Estimated Glomerular Filtration Rate in People With Type 2 Diabetes and Chronic Kidney Disease.JAMA network open · 2023Article
- Long-Term Lithium Therapy: Side Effects and Interactions.Pharmaceuticals (Basel, Switzerland) · 2023Review
- Comparison of Rheumatoid Arthritis Information Recorded in UK CPRD Aurum and CPRD GOLD Databases (Companion Paper 3).Clinical epidemiology · 2023Article
Corrections and comments
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Authors and funding
10 authors at 6 institutions in 3 countries.
Funding
Abstract
backgroundLithium is the most effective treatment in bipolar disorder. Its use is limited by concerns about risk of chronic kidney disease (CKD). We aimed to develop a model to predict risk of CKD following lithium treatment initiation, by identifying individuals with a high-risk trajectory of kidney function.
methodsWe used United Kingdom Clinical Practice Research Datalink (CPRD) electronic health records (EHRs) from 2000 to 2018. CPRD Aurum for prediction model development and CPRD Gold for external validation. We used elastic net regularised regression to generate a prediction model from potential features. We performed discrimination and calibration assessments in an external validation data set. We included all patients aged ≥ 16 with bipolar disorder prescribed lithium. To be included patients had to have ≥ 1 year of follow-up before lithium initiation, ≥ 3 estimated glomerular filtration rate (eGFR) measures after lithium initiation (to be able to determine a trajectory) and a normal (≥ 60 mL/min/1.73 m
resultsThe high risk of deteriorating eGFR group included 191 (11.87%) of the Aurum cohort and 137 (14.67%) of the Gold cohort. Of these, 168 (87.96%) and 117 (85.40%) respectively developed CKD 3a or more severe during follow-up. The model, developed in Aurum, had a ROC area of 0.879 (95%CI 0.853-0.904) in the Gold external validation data set. At the empirical optimal cut-point defined in the development dataset, the model had a sensitivity of 0.91 (95%CI 0.84-0.97) and a specificity of 0.74 (95% CI 0.67-0.82). However, a 3-variable elastic net model (including only age, sex and baseline eGFR) performed similarly well (ROC area 0.888; 95%CI 0.864-0.912), as did the KFRE (ROC area 0.870; 95%CI 0.841-0.898).
conclusionsIndividuals at high risk of a poor eGFR trajectory can be identified before initiation of lithium treatment by a simple equation including age, sex and baseline eGFR. Risk was increased in individuals who were younger at commencement of lithium, female and had a lower baseline eGFR. We did not identify strong predicters of eGFR decline specific to lithium-treated patients. Notably, lithium duration and toxicity were not associated with high-risk trajectory.
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Registered trials
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