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A decision analysis of long-term lithium treatment and the risk of renal failure
Article first published online: 9 MAR 2012
© 2012 John Wiley & Sons A/S
Acta Psychiatrica Scandinavica
Volume 126, Issue 3, pages 186–197, September 2012
How to Cite
Werneke, U., Ott, M., Renberg, E. S., Taylor, D. and Stegmayr, B. (2012), A decision analysis of long-term lithium treatment and the risk of renal failure. Acta Psychiatrica Scandinavica, 126: 186–197. doi: 10.1111/j.1600-0447.2012.01847.x
- Issue published online: 10 AUG 2012
- Article first published online: 9 MAR 2012
- Accepted for publication January 26, 2012
- bipolar disorder;
- decision analysis;
- end-stage renal disease;
Werneke U, Ott M, Salander Renberg E, Taylor D, Stegmayr B. A decision analysis of long-term lithium treatment and the risk of renal failure.
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.