When lithium works in bipolar disorder, it tends to work for the long term. That’s a good thing for the 30% to 40% of patients with bipolar disorder who are lithium responders.1 It means they can stay well longer with fewer medication changes. They can also benefit from the medical benefits of lithium, which include a lower risk of stroke, heart disease, cancer, neurologic illnesses, dementia, and all-cause mortality.2 Unfortunately, all of these benefits come at a cost to the kidneys.
Does lithium harm the kidneys?
While most studies suggest that long-term lithium use can impair renal function, the link is not 100% clear. Bipolar disorder itself is a risk factor for renal impairment, as are the medical conditions that tend to congregate with it: cardiovascular disease, hypertension, and diabetes.3 About a third of the research has failed to confirm the association between lithium and renal impairment, and two large studies found that anticonvulsants posed a greater risk to the kidneys than lithium.4,5
The reason for this confusion is that nearly all the data is uncontrolled. It takes around 30 years for renal problems to develop in patients taking lithium, and we are unlikely to see controlled trials that last that long. Limitations aside, what we can glean from the available data is:
1. Lithium can impair the kidneys, mainly by lowering the glomerular filtration rate
2. These impairments rarely progress to end-stage renal disease
3. Anticonvulsants, and possibly antipsychotics, are also implicated in the problem5,6
Dr Aiken does not accept honoraria from pharmaceutical companies but receives honoraria from W.W. Norton & Co. for Bipolar, Not So Much, coauthored with Jim Phelps, MD.
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