End-stage renal disease associated with prophylactic lithium treatment

Eur Neuropsychopharmacol. 2014 Apr;24(4):540-4. doi: 10.1016/j.euroneuro.2014.01.002. Epub 2014 Jan 17.


The primary aim of this study was to estimate the prevalence of lithium associated end-stage renal disease (ESRD) and to compare the relative risk of ESRD in lithium users versus non-lithium users. Second, the role of lithium in the pathogenesis of ESRD was evaluated. We used the Swedish Renal Registry to search for lithium-treated patients with ESRD among 2644 patients with chronic renal replacement therapy (RRT)-either dialysis or transplantation, within two defined geographical areas in Sweden with 2.8 million inhabitants. The prevalence date was December 31, 2010. We found 30 ESRD patients with a history of lithium treatment. ESRD with RRT was significantly more prevalent among lithium users than among non-lithium users (p<0.001). The prevalence of ESRD with RRT in the lithium user population was 15.0‰ (95% CI 9.7-20.3), and close to two percent of the RRT population were lithium users. The relative risk of ESRD with RRT in the lithium user population compared with the general population was 7.8 (95% CI 5.4-11.1). Out of those 30 patients, lithium use was classified, based on chart reviews, as being the sole (n=14) or main (n=10) cause of ESRD in 24 cases. Their mean age at the start of RRT was 66 years (46-82), their mean time on lithium 27 years (12-39), and 22 of them had been on lithium for 15 years or more. We conclude that lithium-associated ESRD is an uncommon but not rare complication of lithium treatment.

Keywords: Adverse effects; Affective disorders; Chronic; Kidney failure; Lithium.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Antidepressive Agents / adverse effects*
  • Antidepressive Agents / therapeutic use
  • Antimanic Agents / adverse effects*
  • Antimanic Agents / therapeutic use
  • Causality
  • Cohort Studies
  • Comorbidity
  • Cross-Sectional Studies
  • Drug Prescriptions
  • Female
  • Humans
  • Kidney Failure, Chronic / chemically induced*
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / therapy
  • Lithium / adverse effects*
  • Lithium / therapeutic use
  • Male
  • Middle Aged
  • Mood Disorders / drug therapy
  • Mood Disorders / epidemiology
  • Mood Disorders / prevention & control
  • Prevalence
  • Registries
  • Risk
  • Secondary Prevention
  • Sweden / epidemiology


  • Antidepressive Agents
  • Antimanic Agents
  • Lithium