Lithium nephrotoxicity: a systematic review and meta-analysis of lithium versus non-lithium control studies in patients with affective disorders.

IF 4 3区医学 Q2 PHARMACOLOGY & PHARMACY

Therapeutic Advances in Psychopharmacology Pub Date : 2026-02-16 eCollection Date: 2026-01-01 DOI:10.1177/20451253261419633

Marie Michele Macaron, Mireilla Abou Rjeily, Raphael Macaron, Asmaa Yehia, Balwinder Singh, Mark A Frye, Osama A Abulseoud

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引用次数: 0

Abstract

Background: Lithium, the gold standard treatment of bipolar disorder (BD), is thought to cause nephropathy in long-term users. However, the role of confounding variables linked to BD in exerting this adverse effect remains unclear.

Objectives: This paper evaluates kidney function in patients with affective disorders who are taking lithium compared to patients not on lithium treatment.

Design: This article is a systematic review and meta-analysis.

Data sources and methods: A comprehensive search of publications up to October 2023 within Cochrane, Embase, PubMed, Scopus, Web of Science, and CINAHL databases was performed. Three assessors screened and extracted data from eligible observational studies. Risk of bias assessment was done with the ROBINS-E tool. Eligible studies were comparative studies of adult patients with diagnoses of affective disorders, including BD on lithium, with control groups not on lithium, reporting kidney function outcomes.

Results: Mean estimated Glomerular filtration rate (eGFR) showed less favorable outcomes in the lithium group compared to the non-lithium group (n = 1622, MD = -11.14 ml/min/1.73 m², 95% CI: -16.61, -5.68, I ² = 86%). The mean annual eGFR decline comparison favored the non-lithium group (n = 13,280, MD = 0.13 ml/min/1.73 m², 95% CI: 0.06, 0.20,I ² = 0%). Serum creatinine concentration (mg/dl) was found to be higher in the lithium compared to non-lithium groups (n = = 1704, MD = 0.05, 95% CI: 0.03, 0.07,I ² = 3%). New or progressing chronic kidney disease events were not found to be statistically different between the lithium and control groups (n = = 17,740, OR = 2.16, 95% CI: 0.59, 7.94,I ² = 99%). The high heterogeneity in this meta-analysis limits the reliability and interpretability of our results.

Conclusion: Kidney function, as measured by eGFR, was decreased in the lithium-taking groups versus the non-lithium groups. Continuous monitoring and discussion of risks and benefits with patients, especially those with a baseline of reduced kidney function, is imperative.

Trial registration: This review was registered prospectively with PROSPERO (CRD42024517414).

查看原文本刊更多论文

锂肾毒性：情感性障碍患者锂与非锂对照研究的系统回顾和荟萃分析。

背景：锂，双相情感障碍（BD）的金标准治疗，被认为会导致肾病的长期使用者。然而，与双相障碍相关的混杂变量在产生这种不利影响中的作用仍不清楚。目的：本文评价情感性障碍患者服用锂与未服用锂的患者的肾功能。设计：本文是一项系统综述和荟萃分析。数据来源和方法：在Cochrane、Embase、PubMed、Scopus、Web of Science和CINAHL数据库中对截至2023年10月的出版物进行了全面检索。三名评估人员从符合条件的观察性研究中筛选和提取数据。偏倚风险评估采用ROBINS-E工具。符合条件的研究是诊断为情感性障碍的成年患者的比较研究，包括锂盐治疗的BD，与未使用锂盐治疗的对照组，报告肾功能结果。结果：与非锂组相比，锂组的平均估计肾小球滤过率（eGFR）显示较差的结果（n = 1622, MD = -11.14 ml/min/1.73 m2, 95% CI: -16.61, -5.68, I 2 = 86%）。平均每年eGFR下降比较有利于非锂组（n = 13,280, MD = 0.13 ml/min/1.73 m2, 95% CI: 0.06, 0.20, i2 = 0%）。与非锂组相比，锂组血清肌酐浓度（mg/dl）较高（n = = 1704, MD = 0.05, 95% CI: 0.03, 0.07, i2 = 3%）。新发或进展的慢性肾脏疾病事件在锂组和对照组之间没有统计学差异（n = = 17,740, or = 2.16, 95% CI: 0.59, 7.94, i2 = 99%）。本荟萃分析的高异质性限制了我们结果的可靠性和可解释性。结论：与非锂组相比，服用锂组通过eGFR测量的肾功能有所下降。持续监测和讨论患者的风险和益处，特别是那些基线肾功能下降的患者，是必要的。试验注册：本综述在PROSPERO进行前瞻性注册（CRD42024517414）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Therapeutic Advances in Psychopharmacology Multiple-

CiteScore

7.90

自引率

2.40%

发文量

审稿时长

10 weeks

期刊介绍： Therapeutic Advances in Psychopharmacology delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of psychopharmacology. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in psychopharmacology, providing a forum in print and online for publishing the highest quality articles in this area.