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Renal replacement therapy associated with lithium nephrotoxicity in Australia
Author(s) -
Roxanas Milton,
Grace Blair S,
George Charles R P
Publication year - 2014
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja13.10435
Subject(s) - medicine , renal replacement therapy , dialysis , population , cohort , renal function , incidence (geometry) , end stage renal disease , retrospective cohort study , pediatrics , disease , physics , environmental health , optics
Objective: To analyse the annual incidence of end‐stage renal disease (ESRD) associated with lithium‐induced nephropathy (LiN) in Australia. Design, setting and participants: Retrospective cohort study of patients commencing renal replacement therapy (RRT) in Australia. We compared patients with LiN with all other RRT patients between 1 January 1991 and 31 December 2011, using Australia and New Zealand Dialysis and Transplant Registry data. Main outcome measures: Numbers and characteristics of incident RRT patients, primary kidney disease (LiN or other, based on clinical diagnosis). Results: LiN contributed to 187 people in Australia commencing RRT between 1 January 1991 and 31 December 2011. The incidence rate increased from 0.14 cases/million population/year (95% CI, 0.06–0.22) in 1992–1996 to 0.78 (95% CI, 0.67–0.90) in 2007–2011. This increase is unlikely to be attributed solely to demographic changes in Australia. LiN patients were more likely than non‐LiN patients to be women, to be white, to smoke, and to have a higher body mass index, but were less likely to have undergone renal biopsy. Conclusions: Rates of ESRD attributed to LiN are increasing rapidly. Currently accepted lithium dosages and duration of treatment might induce ESRD in a large cohort of patients. We encourage clinicians to exercise discretion when prescribing lithium, check renal function regularly, stop lithium if there is a deterioration in two consecutive readings, and consider substitution with other drugs.