Lithium Use Linked to Higher Risk of Acute Kidney Injury: Study

Side effects of lithium used for bipolar disorder may increase the risk of serious kidney problems compared to other types of stabilizing drugs, according to the findings of a new study.

High doses of lithium are often used to treat bipolar disorder, but Swedish researchers warn that the medication may double the risk of chronic kidney disease (CKD) and acute kidney injury (AKI), when compared to similar drugs, like Depakote. Their findings were published July 7 in Journal of the American Medical Association (JAMA).

Researchers from the Karolinska Institute in Sweden sought to determine the associated risk of kidney outcomes with lithium therapy for bipolar management compared to Depakote, another drug linked to adverse health outcomes. They followed 10,946 bipolar patients from January 2007 through December 2018, using a national health database.

Long Term, High Dose Lithium Use Has the Strongest Link to Acute Kidney Problems

Of the selected patients, 5,308 initiated lithium therapy and 5,638 initiated Depakote therapy for bipolar symptom management during the study period. Researchers then analyzed the patients for two different types of adverse kidney outcomes: chronic kidney disease and acute kidney injury.

According to the findings, patients on high, long-term lithium doses for longer than one year had up to a 30% higher risk of CKD progression than patients taking similar amounts of Depakote. Additionally, the researchers discovered that AKI risk associated with lithium increased exponentially with elevated dosage levels, compared to Depakote. Specifically, the risk of acute kidney injury was 2.5 times higher in bipolar patients on high doses of lithium for more than one year, compared to bipolar patients on Depakote and lower lithium dosages.

Researchers concluded that the long term effects of lithium therapy, especially at high doses, may be a risk factor for bipolar patients using the drug for symptom management. They suggested starting, monitoring, and adjusting lithium therapy as recommended by psychiatric guidelines to decrease the chance of lithium toxicity and associated kidney damage.

“The association between higher lithium levels and AKI (acute kidney injury) calls for continuous patient monitoring and lithium dose adjustment to avoid toxic levels,” researchers determined.

This latest study aligns with prior research linking severe health risks to lithium, which is a naturally occurring trace element with mood stabilizing effects. Health experts have established that long-term lithium use can impair kidney filtration function, potentially resulting in chronic disease like renal failure or acute injuries like kidney cysts.

Current research also suggests that lithium use, especially in pregnant woman, can negatively impact fetal development. A 2018 study found that lithium based medications can increase risk of birth defects by more than 70% when taken during early pregnancy.

Other studies have also raised concern over how environmental lithium levels, especially unregulated amounts in residential drinking water, affect prenatal brain development. A study published earlier this year found that pregnant women who ingest naturally occurring lithium in drinking water are 25% more likely to give birth to a child with autism.