No financial support was received for this paper.
Using hypernatraemic events to predict reduced renal function in elderly lithium patients: a brief report
Version of Record online: 31 MAR 2013
© 2013 The Authors. Psychogeriatrics © 2013 Japanese Psychogeriatric Society
Volume 13, Issue 1, pages 25–28, March 2013
How to Cite
Rej, S., Senouci, S. I., Looper, K. and Segal, M. (2013), Using hypernatraemic events to predict reduced renal function in elderly lithium patients: a brief report. Psychogeriatrics, 13: 25–28. doi: 10.1111/j.1479-8301.2012.00433.x
There are no potential conflicts or disclosures to report.
- Issue online: 31 MAR 2013
- Version of Record online: 31 MAR 2013
- Manuscript Accepted: 3 SEP 2012
- Manuscript Revised: 10 MAY 2012
- Manuscript Received: 15 DEC 2011
- renal failure
Diabetes insipidus (DI) is a recognized adverse effect of lithium use, and studies have shown an association between decreased renal function and DI in patients using lithium. We hypothesize that hypernatraemic events that occur in DI predict decreased renal function in elderly patients on lithium.
We conducted a retrospective cohort study involving 55 geriatric psychiatry patients using lithium between 1985 and 2010. Patients who always had sodium levels ≤146 mmol/L were compared to patients with one or more episodes of hypernatraemia (serum sodium level ≥147 mmol/L) for estimated glomerular filtration rate (eGFR) levels and prevalence of severe chronic renal failure (eGFR ≤30 mL/min/1.73 m2).
eGFR was found to be less in the hypernatraemic group than in the non-hypernatraemic controls (41 vs 56 mL/min/1.73 m2; P = 0.0074). Severe chronic renal failure appeared more prevalent in hypernatraemic patients (4/14 (28.6%) vs. 3/41 (7.3%)), but this did not achieve statistical significance (P = 0.061). The two groups did not differ for age, sex, medical comorbidities or other clinical variables, except antidepressant use. Hypernatraemic patients appeared less likely to use antidepressants than non-hypernatraemic patients, odds ratio = 0.69 (P = 0.020). However, in multivariate analysis, hypernatraemia correlated with decreased eGFR (β = −0.39, P = 0.004), while antidepressant use did not (P = 0.81).
These results suggest that hypernatraemic events may predict reduced renal function in geriatric patients using lithium. The role of hypernatraemia and DI in renal failure in this population requires further study. Health professionals should be aware of the risks of renal failure in older patients treated with lithium, especially in the context of sodium level abnormalities.