AUTHOR=Chang Cheryl W. L. , Ho Cyrus S. H. 

TITLE=Lithium Use in a Patient With Bipolar Disorder and End-Stage Kidney Disease on Hemodialysis: A Case Report

JOURNAL=Frontiers in Psychiatry

VOLUME=Volume 11 - 2020

YEAR=2020

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2020.00006

DOI=10.3389/fpsyt.2020.00006

ISSN=1664-0640

ABSTRACT=Lithium has been implicated in causing chronic tubulointerstitial nephritis and decline in renal function. However, lithium still plays a role in stabilising patients with bipolar disorder. We illustrated a case of a bipolar I disorder patient approaching end-stage kidney disease (ESKD) with other medical comorbidities. As her mental state was affecting her compliance with medical treatment, she was mentally and medically unwell. Our patient was hospitalised on two separate occasions, for 5 and 4 months respectively, and failed adequate trials of different psychotropics due to inefficacy or intolerable side effects. A decision was made between the psychiatrist, nephrologist and cardiologist  to use lithium with haemodialysis support, with good treatment response and improved mental state. This case has shown that lithium carbonate can still be prescribed in ESKD patients on haemodialysis. Daily monitoring of lithium levels in the initial phase of lithium and haemodialysis commencement for at least two weeks is imperative, reducing to 3 times per week pre-haemodialysis towards the end of discharge after three consecutive daily serum lithium levels have stabilised. Clinicians can also consider a target serum level of less than 0.6mEq/L in maintenance treatment for bipolar disorder in patients on haemodialysis.