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Lithium use in a patient on haemodialysis with bipolar affective disorder and lithium-induced nephropathy
  1. Sam Topp1 and
  2. Emma Salisbury2
  1. 1Hounslow Crisis Assessment & Treatment Team, West London Mental Health NHS Trust, Isleworth, UK
  2. 2Renal and Transplant, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Emma Salisbury; emma.salisbury{at}


Lithium is an effective mood stabiliser used to treat bipolar affective disorder (BPAD); however, it can also adversely affect the kidneys, causing acute toxic effects, nephrogenic diabetes insipidus, chronic renal dysfunction and end-stage kidney disease (ESKD) in a minority of patients. We describe the case of a man with a 34-year history of BPAD type-1 and a 2-year history of ESKD secondary to lithium-induced nephropathy who experienced a manic relapse. He previously responded well to lithium but, following a deterioration in kidney function, was switched to olanzapine and sodium valproate. This precipitated a period of instability, which culminated in a treatment-resistant manic episode requiring hospital admission. After a multidisciplinary team discussion, lithium therapy was restarted and provided remission. This was achieved safely through a reduced dosing schedule of three times a week post dialysis, slow dose titration and blood level monitoring prior to each dialysis session.

  • psychiatry (drugs and medicines)
  • bipolar i disorder
  • chronic renal failure
  • dialysis

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  • Contributors Conception of report (ES), data collection (ES), data analysis and interpretation (ES and ST), drafting the article (ST), critical revision of the article (ST and ES) and final approval of the version to be published (ES)

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.