Change search
ReferencesLink to record
Permanent link

Direct link
A decision analysis of long-term lithium treatment and the risk of renal failure
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Division of Internal Medicine, Department of Nephrology, Sunderby Hospital, Luleå, Sweden.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
Show others and affiliations
2012 (English)In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 126, no 3, 186-197 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To establish whether lithium or anticonvulsant should be used for maintenance treatment for bipolar affective disorder (BPAD) if the risks of suicide and relapse were traded off against the risk of end-stage renal disease (ESRD).

Method: Decision analysis based on a systematic literature review with two main decisions: (1) use of lithium or at treatment initiation and (2) the potential discontinuation of lithium in patients with chronic kidney disease (CKD) after 20 years of lithium treatment. The final endpoint was 30 years of treatment with five outcomes to consider: death from suicide, alive with stable or unstable BPAD, alive with or without ESRD.

Results: At the start of treatment, the model identified lithium as the treatment of choice. The risks of developing CKD or ESRD were not relevant at the starting point. Twenty years into treatment, lithium still remained treatment of choice. If CKD had occurred at this point, stopping lithium would only be an option if the likelihood of progression to ESRD exceeded 41.3% or if anticonvulsants always outperformed lithium regarding relapse prevention.

Conclusion: At the current state of knowledge, lithium initiation and continuation even in the presence of long-term adverse renal effects should be recommended in most cases.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2012. Vol. 126, no 3, 186-197 p.
Keyword [en]
bipolar disorder, decision analysis, end-stage renal disease, lithium, suicide
National Category
URN: urn:nbn:se:umu:diva-59517DOI: 10.1111/j.1600-0447.2012.01847.xISI: 000307375500004OAI: diva2:552977
Available from: 2012-09-17 Created: 2012-09-17 Last updated: 2016-02-04Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full text

Search in DiVA

By author/editor
Werneke, UrsulaOtt, MichaelSalander Renberg, EllinorStegmayr, Bernd
By organisation
In the same journal
Acta Psychiatrica Scandinavica

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 94 hits
ReferencesLink to record
Permanent link

Direct link