Impaired renal function & lithium

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Principles
  • Lithium is nephrotoxic and contra-indicated in severe renal impairment.
  • Use with extreme care, close monitoring, reduced dosing and following consultation with renal medicine and biochemistry.
  • Toxicity is more likely.
  • A full discussion of the additional risks must be undertaken with the patient and consent obtained and documented.

Referral to renal medicine should be made if

  • eGFR falls rapidly to <45ml/min.
  • Significant proteinuria (identified by albumin creatinine ratio).
  • A steady or persistent fall in eGFR.
  • eGFR <30ml/min (Stages 4 or 5 of chronic kidney disease).

Lithium levels and renal function should be monitored more frequently and at least monthly for patients with altered renal function.

Editorial Information

Last reviewed: 03 September 2019

Next review: 12 July 2021

Author(s): PMG-MH

Version: 1

Approved By: PMG-MH

Reviewer Name(s): Andrew Walker, Suzanne Burke