Bipolar drug therapy tied to nephrotoxicity

  • Nestsiarovich A & al.
  • J Affect Disord
  • 8 Apr 2019

  • International Clinical Digest
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Takeaway

  • Lithium-based drugs used to treat bipolar disorder may be nephrotoxic.

Why this matters

  • Research findings on renal safety of bipolar drugs remain inconsistent, and restricted to a few commonly used agents and combinations.

Study design

  • Analysis of data from 591,052 commercially insured US adults with bipolar disorder (65.0% female; mean age, 38.3 years) during 2003-2015; none had baseline kidney disease.
  • Funding: Patient-Centered Outcomes Research Institute award.     

Key results

  • 71 drugs and drug combinations were identified (18 monotherapies, 53 combinations).
  • 27.0% used no drugs, 40.6% received monotherapy, and 32.4% received polypharmacy.
  • Kidney disease was diagnosed in 14,713 patients (2.5%); 60.6% were female, mean age was 44.7 years.
    • 28.0% of cases were considered "high severity"—life-threatening, debilitating, and potentially/probably irreversible.
  • HR estimates for all kidney disease and severe disease reached maximums of 2.66 and 5.30, respectively.
  • Most combinations with lithium, mood-stabilizing anticonvulsants, or antipsychotics increased kidney disease risk vs no drugs (P<.05>
  • Risk was highest with monoamine oxidase inhibitors (HR=2.66; P=5.73×10−5).
  • Lithium monotherapy was tied to risks for all (HR=1.27; P=2.41×108) and severe kidney disease (HR=1.82; P=4.73×1017).
  • Risk for serious kidney disease was highest with lithium-containing, 4-drug-class combinations (HR=5.30; P=2.46×109).

Limitations

  • Reliance on pharmacy claims, ICD-9/10 codes.

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