Log in with your email address username.

×

Important notice

doctorportal Learning is on the move as we will be launching a new website very shortly. If you would like to sign up to dp Learning now to register for CPD learning or to use our CPD tracker, please email support@doctorportal.com.au so we can assist you. If you are already signed up to doctorportal Learning, your login will work in the new site so you can continue to enrol for learning, complete an online module, or access your CPD tracker report.

To access and/or sign up for other resources such as Jobs Board, Bookshop or InSight+, please go to www.mja.com.au, or click the relevant menu item and you will be redirected.

All other doctorportal services, such as Find A Doctor, are no longer available.

Renal replacement therapy associated with lithium nephrotoxicity in Australia

- Featured Image

To the Editor: Adam1 contends that Roxanas and colleagues2 have overemphasised the risk of renal replacement therapy (RRT) associated with lithium treatment. I disagree.

Lithium nephrotoxicity appears to require about a decade of treatment to develop3 and a further 10–20 years before RRT is necessary.3,4 Adam inappropriately divides the number of incident cases of RRT attributed to lithium use by the number of patients currently taking lithium. Rather, cumulative incidence estimates for RRT derived from cohort studies are required.5

Adam calculates that the risk of RRT due to lithium use is lower in Australia than in Sweden, but he uses prevalent cases from Sweden and incident cases from Australia. I calculate that, over a 5-year period, the average annual incident rate of RRT attributed to lithium use per million population is 0.82 in Sweden (95% CI, 0.41–1.47)3 compared with 0.78 in Australia (95% CI, 0.67–0.90).2 The current prevalence of lithium prescribing is also similar — 1150 per million in Australia2 and 1255 in Sweden3

email