Renal concerns relative to the use of lithium in geriatric bipolar disorder patients

BACKGROUND: Lithium is a first-line treatment for bipolar disorder in geri­atric patients; however, it has long been associated with potentially signifi­cant renal consequences, including chronic kidney disease (CKD).

METHODS: We reviewed the available evidence to characterize the effects of lithium on renal function, provide a consensus on periodic monitoring, and propose criteria for transitioning an older patient with bipolar disor­der and renal issues to an alternate medication.

RESULTS: Although the evidence on lithium use, duration, and dosage on progression of CKD and end-stage renal disease in geriatric patients is mixed, there is solid evidence that patients receiving lithium generally have a reduced glomerular filtration rate compared with controls. The current guidelines for monitoring lithium use in geriatric patients are nearly sufficient, but adherence in clinical practice frequently falls short. Alternative medications for bipolar disorder in geriatric patients are generally considered safe and effective, but do not have the strength of evidence that exists in the general adult population.

CONCLUSIONS: Currently, there is no compelling evidence that lithium should be avoided in geriatric patients; however, prudent monitoring strategies are recommended, with a strong consideration of transitioning geriatric patients with poor tolerance to an alternative medication.

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