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Renal replacement therapy associated with lithium nephrotoxicity in Australia

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In 1949, John Cade reported the use of lithium in the treatment of manic–depressive illness, thus ushering in the era of psychopharmacology.1 Clinicians soon observed that patients receiving long-term lithium therapy developed polyuria, suggesting that it might cause renal tubular damage.2 Many years later, evidence arose that it might also reduce renal function, although the initial report included some patients with lithium toxicity.3 A meta-analysis of 1172 patients across 14 studies found that 15% of patients had a reduced glomerular filtration rate (GFR).4 This led to a discussion of the lithium level sufficient to control symptoms but not to create permanent renal damage.5

Controversy regarding the level of risk persisted. One authority rejected the possibility of renal damage;6 however, a recent meta-analysis of 365 studies disagreed with this but concluded that the risk of renal replacement therapy (RRT) was low (18/3369 patients [0.5%]).7

The need for an epidemiological survey was advocated;8 however, until…