Lithium for Bipolar Disorder and Risk of Thyroid Dysfunction and Chronic Kidney Disease
Authors' conclusion
In this cohort study of patients with incident BD, lithium was associated with a mildly increased risk of thyroid dysfunction and CKD in a predominantly Chinese population. The identified lithium level thresholds associated with risks of physical complications may facilitate the development of evidence-based guidelines recommending lithium treatment, particularly in Asian populations, and the promotion of personalized care and risk-benefit balancing in the treatment for BD.
Study context
- Population
- Patients aged ≥15 years with first-diagnosed bipolar disorder (BD), Hong Kong, 2002–20187,029 with CKD data
- Exposure
- Lithium vs nonlithium treatment
- Outcome
- Hypothyroidism, hyperthyroidism and CKD stage 3 or higher (CKD3+), ascertained by laboratory results
Methodological detailsmedical record database of public health care services, Data analysis February to May 2024
- Medical record database of public health care services
- Data analysis February to May 2024
Main finding
As reported in the abstract
Observational data: associations, not effects.
Further findings
Higher lithium serum levels
- Hypothyroidism, aHR
- 2.08 (1.67-2.59) (95% CI)
- Hyperthyroidism, aHR
- 1.81 (1.31-2.50) (95% CI)
- CKD3+, aHR
- 2.11 (1.57-2.85) (95% CI)
Lithium toxicity episodes
- Greater number of lithium toxicity episodes associated with increased CKD3+ risk
Individual nonlithium agents vs lithium
- Valproate, olanzapine, quetiapine and risperidone generally had reduced likelihood of thyroid dysfunction and CKD3+ vs lithium, no difference in advanced CKD
Mean lithium serum level thresholds (ROC, Youden index)
- Hypothyroidism
- >0.5028 mEq/L
- Hyperthyroidism
- >0.5034 mEq/L
- CKD3+
- >0.5865 mEq/L
Original publication
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