Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-27T01:15:25.276Z Has data issue: false hasContentIssue false
  • English
  • Français

Managing polyuria during lithium treatment: a preliminary prospective observational study

Published online by Cambridge University Press:  10 April 2019

J. C. Kinahan ,
A. Ní Chorcoráin ,
S. Cunningham ,
S. Barry  and
B. D. Kelly Open the ORCID record for B. D. Kelly [Opens in a new window]
J. C. Kinahan
Affiliation:
College of Medicine and Health, School of Medicine, Brookfield Health Sciences Complex, University College Cork, College Road, Cork, Ireland Department of Psychiatry, Cork University Hospital, Cork, Ireland
A. Ní Chorcoráin
Affiliation:
College of Medicine and Health, School of Medicine, Brookfield Health Sciences Complex, University College Cork, College Road, Cork, Ireland Department of Psychiatry, Cork University Hospital, Cork, Ireland
S. Cunningham
Affiliation:
Department of Pathology and Laboratory Medicine, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
S. Barry
Affiliation:
Cluain Mhuire Community Mental Health Service, Blackrock, Dublin, Ireland
B. D. Kelly*
Affiliation:
Department of Psychiatry, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin 24, Ireland
*
*Address for correspondence: Professor Brendan Kelly, Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin D24 NR0A, Ireland. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Lithium-treated patients with polyuria are at increased risk of lithium toxicity. We aimed to describe the clinical benefits and risks of different management strategies for polyuria in community lithium-treated patients.

Methods:

This is a naturalistic, observational, prospective 12-month cohort study of lithium-treated patients with polyuria attending a community mental health service in Dublin, Ireland. When polyuria was detected, management changed in one of four ways: (a) no pharmacological change; (b) lithium dose decrease; (c) lithium substitution; or (d) addition of amiloride.

Results:

Thirty-four participants were diagnosed with polyuria and completed prospective data over 12 months. Mean 24-hour urine volume decreased from 4852 to 4344 ml (p = 0.038). Mean early morning urine osmolality decreased from 343 to 338 mOsm/kg (p = 0.823). Mean 24-hour urine volume decreased with each type of intervention but did not attain statistical significance for any individual intervention group. Mean early morning urine osmolality decreased in participants with no pharmacological change and increased in participants who received a change in medication but these changes did not attain statistical significance. Only participants who discontinued lithium demonstrated potentially clinically significant changes in urine volume (mean decrease 747 ml in 24 hours) and early morning urine osmolality (mean increase 31 mOsm/kg) although this was not definitively proven, possibly owing to power issues.

Conclusions:

Managing polyuria by decreasing lithium dose does not appear to substantially improve objective measures of renal tubular dysfunction, whereas substituting lithium may do so. Studies with larger numbers and longer follow-up would clarify these relationships.

Keywords

Lithiumpolyuriarenal tubular dysfunctionnephrogenic diabetes insipidusamiloride
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 39 , Issue 1 , March 2022 , pp. 20 - 27
Copyright
© The Author(s), 2019. Published by Cambridge University Press on behalf of The College of Psychiatrists of Ireland

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Batlle, DC, von Riotte, AB, Gaviria, M, Grupp, M (1985). Amelioration of polyuria by amiloride in patients receiving long-term lithium therapy. New England Journal of Medicine 312, 408–414.10.1056/NEJM198502143120705CrossRefGoogle ScholarPubMed
Bedford, JJ, Weggery, S, Ellis, G, McDonald, FJ, Joyce, PR, Leader, JP, Walker, RJ (2008). Lithium-induced nephrogenic diabetes insipidus: renal effects of amiloride. Clinical Journal of the American Society of Nephrology 3, 1324–1331.10.2215/CJN.01640408CrossRefGoogle ScholarPubMed
Bendz, H (1985). Kidney function in a selected lithium population. A prospective, controlled, lithium-withdrawal study. Acta Psychaitrica Scandinavica 72, 451–463.10.1111/j.1600-0447.1985.tb02639.xCrossRefGoogle Scholar
Bendz, H, Sjödin, I, Aurell, M (1996). Renal function on and off lithium in patients treated with lithium for 15 years or more. A controlled, prospective lithium-withdrawal study. Nephrology, Dialysis, Transplantation 11, 457–460.10.1093/oxfordjournals.ndt.a027311CrossRefGoogle ScholarPubMed
Bendz, H, Aurell, M, Balldin, J, Mathe, AA, Sjödin, I (1994). Kidney damage in long-term lithium patients: a cross-sectional study of patients with 15 years or more on lithium. Nephrology, Dialysis, Transplantation 9, 1250–1254.Google ScholarPubMed
Berl, T, Raz, A, Wald, H, Horowitz, J, Czaczkes, W (1977). Prostaglandin synthesis inhibition and the action of vasopressin: studies in man and rat. American Journal of Physiology 232, F529–F537.Google ScholarPubMed
Bichet, DG (2017). Clinical manifestations and causes of central diabetes insipidus (https://www.uptodate.com/contents/clinical-manifestations-and-causes-of-central-diabetes-insipidus). Accessed 6 January 2019.Google Scholar
Boton, R, Gaviria, M, Batlle, DC (1987). Prevalence, pathogenesis, and treatment of renal dysfunction associated with chronic lithium therapy. American Journal of Kidney Disease 10, 329–345.10.1016/S0272-6386(87)80098-7CrossRefGoogle ScholarPubMed
Bucht, G, Wahlin, A (1980). Renal concentrating capacity in long-term lithium treatment and after withdrawal of lithium. Acta Medica Scandinavica 207, 309–314.10.1111/j.0954-6820.1980.tb09726.xCrossRefGoogle ScholarPubMed
DePaulo, JR, Correa, EI, Sapir, DG (1984). The pattern of polyuria in relation to duration of lithium treatment. Biological Psychiatry 19, 1345–1349.Google ScholarPubMed
Forrest, JN, Cohen, AD, Torretti, J, Himmelhoch, JM, Epstein, FH (1974). On the mechanism of lithium-induced diabetes insipidus in man and the rat. Journal of Clinical Investigation 53, 1115–1123.10.1172/JCI107649CrossRefGoogle ScholarPubMed
Garofeanu, CG, Weir, M, Rosas-Arellano, MP, Henson, G, Garg, AX, Clark, WF (2005). Causes of reversible nephrogenic diabetes insipidus: a systematic review. American Journal of Kidney Disease 45, 626–637.10.1053/j.ajkd.2005.01.008CrossRefGoogle ScholarPubMed
Grünfeld, JP, Rossier, BC (2009). Lithium nephrotoxicity revisited. Nature Reviews. Nephrology 5, 270–276.10.1038/nrneph.2009.43CrossRefGoogle ScholarPubMed
Hetmar, O, Clemmesen, L, Ladefoged, J, Rafaelsen, OJ (1987). Lithium: long-term effects on the kidney. III. Prospective study. Acta Psychiatrica Scandinavica 75, 251–258.10.1111/j.1600-0447.1987.tb02785.xCrossRefGoogle ScholarPubMed
Hetmar, O, Povlsen, UJ, Ladefoged, J, Bolwig, TG (1991). Lithium: long-term effects on the kidney. A prospective follow-up study ten years after kidney biopsy. British Journal of Psychiatry 158, 53–58.10.1192/bjp.158.1.53CrossRefGoogle ScholarPubMed
Kinahan, JC, Ní Chorcoráin, A, Cunningham, S, Freyne, A, Cooney, C, Barry, S, Kelly, BD (2015a). Risk factors for polyuria in a cross-section of community psychiatric lithium-treated patients. Bipolar Disorders 17, 50–62.10.1111/bdi.12235CrossRefGoogle Scholar
Kinahan, JC, Ní Chorcoráin, A, Cunningham, S, Freyne, A, Cooney, C, Barry, S, Kelly, BD (2015b). Diagnostic accuracy of tests for polyuria in lithium-treated patients. Journal of Clinical Psychopharmacology 35, 434–441.10.1097/JCP.0000000000000350CrossRefGoogle ScholarPubMed
Livingstone, C, Rampes, H (2006). Lithium: a review of its metabolic adverse effects. Journal of Psychopharmacology 20, 347–355.10.1177/0269881105057515CrossRefGoogle ScholarPubMed
Lokkegaard, H, Andersen, NF, Henriksen, E, Bartels, PD, Brahm, M, Baastrup, PC, Jørgensen, HE, Larsen, M, Munck, O, Rasmussen, K, Schröder, H (1985). Renal function in 153 manic-depressive patients treated with lithium for more than five years. Acta Psychiatrica Scandinavica 71, 347–355.10.1111/j.1600-0447.1985.tb02534.xCrossRefGoogle ScholarPubMed
Malhi, GS, Tanious, M (2011). Optimal frequency of lithium administration in the treatment of bipolar disorder: clinical and dosing considerations. CNS Drugs 25, 289–298.10.2165/11586970-000000000-00000CrossRefGoogle ScholarPubMed
Malhi, GS, Tanious, M, Gershon, S (2011). The lithiumeter: a measured approach. Biplolar Disorders 13, 219–226.10.1111/j.1399-5618.2011.00918.xCrossRefGoogle ScholarPubMed
Martin, A (1993). Clinical management of lithium-induced polyuria. Hospital and Community Psychiatry 44, 427–428.Google ScholarPubMed
Rej, S, Herrmann, N, Shulman, K (2012). The effects of lithium on renal function in older adults - a systematic review. Journal of Geriatric Psychiatry and Neurology 25, 51–61.10.1177/0891988712436690CrossRefGoogle ScholarPubMed
Shine, B, McKnight, RF, Leaver, L, Geddes, JR (2015). Long-term effects of lithium on renal, thyroid and parathyroid function: a retrospective analysis of laboratory data. Lancet 386, 461–468.10.1016/S0140-6736(14)61842-0CrossRefGoogle ScholarPubMed
Stokes, JB (1981). Integrated actions of renal medullary prostaglandins in the control of water excretion. American Journal of Physiology 240, F471–F480.Google ScholarPubMed
Vestergaard, P, Amdisen, A (1981). Lithium treatment and kidney function. A follow-up study of 237 patients in long-term treatment. Acta Psychiatrica Scandinavica 63, 333–345.10.1111/j.1600-0447.1981.tb00682.xCrossRefGoogle ScholarPubMed
Vestergaard, P, Amdisen, A, Hansen, HE, Schou, M (1979). Lithium treatment and kidney function. A survey of 237 patients in long-term treatment. Acta Psychiatrica Scandinavica 60, 504–520.10.1111/j.1600-0447.1979.tb00559.xCrossRefGoogle ScholarPubMed
Vestergaard, P, Amdisen, A, Schou, M (1980). Clinically significant side effects of lithium treatment. A survey of 237 patients in long-term treatment. Acta Psychiatrica Scandinavica 62, 193–200.10.1111/j.1600-0447.1980.tb00607.xCrossRefGoogle ScholarPubMed
Waller, DG, Edwards, JG, Naik, R, Polak, A (1984). Renal function during lithium treatment. Quarterly Journal of Medicine 53, 369–379.Google ScholarPubMed