Systematic review and practical guideline for the prevention and management of the renal side effects of lithium therapy

• Published in: European neuropsychopharmacology Vol. 31; pp. 16 - 32
• Main Authors: Schoot, Tessa S., Molmans, Thomas H.J., Grootens, Koen P., Kerckhoffs, Angèle P.M.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-02-2020
• Subjects: Antimanic Agents - administration & dosage; Antimanic Agents - adverse effects; Bipolar Disorder - diagnosis; Bipolar Disorder - drug therapy; Chronic renal insufficiency; Diabetes Insipidus, Nephrogenic - chemically induced; Diabetes Insipidus, Nephrogenic - diagnosis; Diabetes Insipidus, Nephrogenic - prevention & control; Humans; Lithium; Lithium Compounds - administration & dosage; Lithium Compounds - adverse effects; Nephrogenic diabetes insipidus; Practice Guidelines as Topic - standards; Withholding Treatment - standards; Nephrogenic diabetes insipidus; Chronic renal insufficiency; Lithium
• ISSN: 0924-977X; 1873-7862
• DOI: 10.1016/j.euroneuro.2019.11.006

Lithium is the first line therapy of bipolar mood disorder. Lithium-induced nephrogenic diabetes insipidus (Li-NDI) and lithium nephropathy (Li-NP, i.e., renal insufficiency) are prevalent side effects of lithium therapy, with significant morbidity. The objective of this systematic review is to provide an overview of preventive and management strategies for Li-NDI and Li-NP. For this, the PRISMA guideline for systematic reviews was used. Papers on the prevention and/or treatment of Li-NDI or Li-NP, and (influenceable) risk factors for development of Li-NDI or Li-NP were included. We found that the amount of evidence on prevention and treatment of Li-NDI and Li-NP is scarce. To prevent Li-NDI and Li-NP we advise to use a once-daily dosing schedule, target the lowest serum lithium level that is effective and prevent lithium intoxication. We emphasize the importance of monitoring for Li-NDI and Li-NP, as early diagnosis and treatment can prevent further progression and permanent damage. Collaboration between psychiatrist, nephrologist and patients themselves is essential. In patients with Li-NDI and/or Li-NP cessation of lithium therapy and/or switch to another mood stabilizer should be considered. In patients with Li-NDI, off label therapy with amiloride can be useful.