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Concurrent lithium and haemodialysis treatment: Clinical recommendations based on the literature and a multicentre survey
Kuiper,W.J. Grootens,K.P. Kerckhoffs,A.P.M.
Kuiper,W.J.
Grootens,K.P.
Kerckhoffs,A.P.M.
Abstract
Introduction Lithium has an irreplaceable role in the treatment of severe mood disorders, but declining renal function associated with its use leads to clinical dilemmas. Although not often applied, and requiring close monitoring and multidisciplinary actions, concurrent lithium and haemodialysis treatment (CLHT) is a feasible option. To our knowledge, however, there are no detailed consensus- or evidence-based treatment guidelines or directives on its delivery. Methods To fill this gap, we reviewed the literature and surveyed psychiatrists and nephrologists with experience in CLHT using a self-designed questionnaire. Our goal was to form an integrated picture of the current knowledge and clinical practices of CLHT and formulate practical recommendations for colleagues being confronted with patients with renal dysfunction requiring lithium to help manage their mood disorder. Results We identified 14 case reports and case series describing CLHT and one systematic review concluding CLHT to be effective. Ten nephrologists and six psychiatrists practising in the Netherlands completed our questionnaire, providing details on collaboration, lithium dosing regimens, serum level evaluations and additional amenities and services they deemed necessary during CLHT delivery. Discussion We found that CLHT appears to be safe and effective and argue that delivery is a shared responsibility and needs continuous multidisciplinary finetuning. To facilitate delivery, we provide a flowchart for the initiation or reinstatement of lithium therapy in haemodialysis patients and a practical guide for CLHT, including an easy-to-use rule of thumb for calculating the lithium target dose.
Description
Date
2024
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Volume Title
Publisher
Research Projects
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Keywords
bipolar disorder, end-stage kidney disease, haemodialysis, lithium, mood disorder, renal replacement, SDG 3 - Good Health and Well-being
Citation
Kuiper, W J, Grootens, K P & Kerckhoffs, A P M 2024, 'Concurrent lithium and haemodialysis treatment : Clinical recommendations based on the literature and a multicentre survey', Bipolar Disorders, vol. 26, no. 4, pp. 335-347. https://doi.org/10.1111/bdi.13390