Lithium remains a leading long-term treatment for bipolar disorder but is associated with potential renal risks, particularly chronic kidney disease (CKD). In this large retrospective study of more than 4,000 patients treated with lithium, 620 experienced at least one episode of severe kidney impairment (eGFR < 30 ml/min/1.73 m²), though only 153 developed confirmed CKD stage 4. About half of these cases were transient and reversible. Patient survival after CKD4 was strongly linked to age rather than lithium continuation. Many patients remained on lithium post-CKD4 or even during renal replacement therapy (RRT), with no significant impact on survival, suggesting that discontinuation may not always improve renal outcomes.

The study highlights that lithium-related kidney decline often progresses slowly and that outcomes depend more on age and comorbidities than treatment cessation. Most patients with CKD had significant somatic illnesses, notably cardiovascular disease. Continued lithium use, when well-monitored, may be appropriate even after renal impairment, especially to avoid psychiatric relapse. These findings support close collaboration between psychiatrists and nephrologists, early recognition of “creeping creatinine,” and proactive renal monitoring. Importantly, many patients with severe renal decline are missed in RRT-based assessments, underscoring the need for more comprehensive tracking.

Reference: Aiff H, Attman PO, Golic M, et al. Prospects for lithium treated patients with severe renal impairment. Int J Bipolar Disord. 2025 Feb 14;13(1):5. doi: 10.1186/s40345-025-00372-z. PMID: 39953220; PMCID: PMC11828763.