Lithium is an important medication in the treatment of
mood disorders. However, clinicians are hesitant to use
lithium in older adults for fear of its medical effects, particularly
kidney disease. This review describes the current understanding of the epidemiology and mechanisms underlying
chronic kidney disease (CKD) in older
lithium users, with recommendations for using
lithium safely in late life. Prevalence estimates of CKD in older
lithium users range from 42-50%, which does not differ greatly from the 37.8% rates seen in community-dwelling non-
lithium using, non-psychiatric populations. Clinical and pre-clinical data suggest a variety of synergistic mechanisms contributing to CKD in older
lithium users, including aging, cardiovascular factors, oxidative stress,
inflammation,
nephrogenic diabetes insipidus,
acute kidney injury, and medication interactions. With regards to CKD,
lithium can be used safely in many older adults with
mood disorders. Compared to patients with pre-existing CKD, those with an estimated glomerular filtration rate >60 mL/min/1.73 m(2) are probably not as susceptible to
lithium-associated renal decline. Using
lithium concentrations <0.8 mmol/L; monitoring
lithium concentrations and renal function every 3-6 months; being vigilant about concurrent medication use (e.g.,
diuretics,
anti-inflammatories); as well as preventing/treating
acute kidney injury,
nephrogenic diabetes insipidus,
diabetes mellitus,
hypertension, smoking, and
coronary artery disease can all help prevent CKD and further renal decline in older
lithium users.