Lifetime risk of severe kidney disease in lithium-treated patients: a retrospective study.

Background: Lithium is an essential psychopharmaceutical, yet side effects and concerns about severe renal function impairment limit its usage.

Aims: Our objectives were to quantify the occurrence of chronic kidney disease stage 4 or higher (CKD4 +) within a lithium-treated population, using age- and time-specific cumulative incidence and age-specific lifetime risk as measures of disease occurrence. Additionally, we aimed to investigate the association between the duration of lithium treatment and the risk of CKD4 + .

The low risk for early renal damage during lithium treatment has not changed over time.

Background: Modern lithium management guidelines were introduced to improve the renal prognosis of lithium patients.

Aims: To examine whether prospects for severe renal impairment (defined as chronic kidney disease at least stage 4 (CKD4)), in long-term lithium patients, have changed over time after the introduction of lithium monitoring guidelines.

Methods: The time to and hazard for CKD4 were compared between three patient cohorts who started long-term lithium in three consecutive decades: 1980s, 1990s and 2000s.

Starting lithium in patients with compromised renal function - is it wise?

Background: Little is known of the risks involved for patients who, at the start of lithium treatment, already have compromised renal function.

Aims: To assess the risk of developing severe renal impairment (chronic kidney disease (CKD) 4-5) among those patients and to explore predictors for the progression.

Methods: A retrospective longitudinal cohort study using data from Sahlgrenska University Hospital's laboratory database 1981-2017.

Cardiovascular comorbidity increases the risk for renal failure during prophylactic lithium treatment.

Background: The development of lithium-associated kidney damage is still a matter of controversy. We have addressed this question by investigating the role of somatic comorbidity for developing kidney failure in lithium treated patients.

Methods: The study group comprised of 1741 adult patients with normal creatinine levels at the start of lithium treatment.

A practical approach to low protein diets in Sweden- 45 years of clinical use.

This review provides an overview of the development, implementation and practise of low protein diets (LPD) in Sweden. While the current practice is discussed in general terms emphasizing the interplay between nephrologists and dieticians, the "self-selected" LPD model is explained as a practical approach to facilitated patient's adherence to the nutritional therapy. This model is currently implemented in most clinics of the country and gives considerable flexibility regarding variation in meal planning, food selection, amounts consumed, cooking methods as well as adaptations to day-to-day changes.

Effects of 10 to 30 years of lithium treatment on kidney function.

Long-term lithium treatment is associated with end-stage renal disease, but there is little evidence of a clinically significant reduction in renal function in most patients. We previously found that 1.5% of people who took lithium from the 1960s and 1970s developed end-stage renal disease; however, none of the patients who started after 1980 had end-stage renal disease.

End-stage renal disease associated with prophylactic lithium treatment.

The primary aim of this study was to estimate the prevalence of lithium associated end-stage renal disease (ESRD) and to compare the relative risk of ESRD in lithium users versus non-lithium users. Second, the role of lithium in the pathogenesis of ESRD was evaluated. We used the Swedish Renal Registry to search for lithium-treated patients with ESRD among 2644 patients with chronic renal replacement therapy (RRT)-either dialysis or transplantation, within two defined geographical areas in Sweden with 2.

The impact of modern treatment principles may have eliminated lithium-induced renal failure.

We have previously shown that lithium can cause end-stage renal disease (ESRD): however, this serious side-effect of lithium in prophylactic treatment of mood disorders may reflect the treatment regime of the 1960s and 1970s. Today's modern treatment routines, intended to reduce or eliminate lithium-induced ESRD (Li-ESRD), were introduced in Sweden in the early 1980s. The aim of the present study was to test the hypothesis that these routines have eliminated the risk of Li-ESRD.

Oxidative stress and inflammation in renal patients and healthy subjects.

The first goal of this study was to measure the oxidative stress (OS) and relate it to lipoprotein variables in 35 renal patients before dialysis (CKD), 37 on hemodialysis (HD) and 63 healthy subjects. The method for OS was based on the ratio of cholesteryl esters (CE) containing C18/C16 fatty acids (R2) measured by gas chromatography (GC) which is a simple, direct, rapid and reliable procedure. The second goal was to investigate and identify a triacylglycerol peak on GC, referred to as TG48 (48 represents the sum of the three fatty acids carbon chain lengths) which was markedly increased in renal patients compared to healthy controls.

Lipoprotein abnormalities in patients with atherosclerotic renovascular disease.

Background: Patients with atherosclerotic renovascular disease (ARVD) have a high risk of cardiovascular death. The primary aim was to characterize abnormalities in apolipoprotein (Apo)-defined lipoprotein (Lp) subclasses in patients with ARVD.

Methods: Baseline measurements were performed on 42 patients with ARVD 4 weeks after renal angioplasty (PTRA).

The effect of decreasing renal function on lipoprotein profiles.

Background: Progressive chronic kidney disease (CKD) is accompanied by dyslipidemia that is characterized by increased concentrations of intact and partially metabolized ApoB and ApoC-III-containing triglyceride-rich lipoproteins in very low-density lipoprotein, intermediate density lipoprotein (IDL) and low-density lipoprotein. The purpose of the present study was to characterize the distribution of individual discrete lipoprotein subclasses in relation to the glomerular filtration rate (GFR) in nondiabetic CKD subjects.

Methods: Fifty-one subjects (33 patients with CKD and 18 asymptomatic subjects) with GFR ranging from 12 to 120 mL/min were studied.

Renal failure occurs in chronic lithium treatment but is uncommon.

We sought to establish the prevalence of lithium-induced end-stage renal disease in two regions of Sweden with 2.7 million inhabitants corresponding to about 30% of the Swedish population. Eighteen patients with lithium-induced end-stage renal disease were identified among the 3369 patients in the general lithium-treated population, representing a sixfold increase in prevalence compared with the general population for renal replacement therapy.

Dyslipidemia of kidney disease.

Purpose Of Review: Chronic kidney disease is associated with specific alterations of lipoprotein metabolism that may be linked to accelerated atherosclerosis and cardiovascular disease. This review summarizes current knowledge of the pathophysiology of renal dyslipidemia and the therapeutic options.

Recent Findings: The renal dyslipidemia is characterized by accumulation of intact and partially metabolized triglyceride-rich apoB-containing and apoC-containing lipoproteins.

Positive effects of protein restriction in patients with chronic kidney disease.

Objectives: The potential benefit or harm of low-protein diets (LPDs) for patients with chronic kidney disease has been debated. This study sought to investigate the effects of treatment with LPDs on nutritional markers, morbidity, and survival during subsequent dialysis. A second objective was to evaluate the effect of LPDs on renal function and the start of dialysis.

Protein restriction and body composition in renal disease.

Objective: To study the effect of low-protein diet (LPD) on body composition (BC).

Study Design: A systematic review of the literature investigating BC during LPD treatment using total body potassium, dual energy X-ray absorptiometry, bioelectrical impedance analysis, and anthropometry.

Patients: Studies reporting data of patients treated with LPD 0.

Candesartan cilexetil in haemodialysis patients.

Objective: Intermittent activation of the renin-angiotensin system during dialysis may be related to the high risk of cardiovascular disease in dialysis patients. The aim of the present study was to investigate the pharmacokinetics and short-term tolerability of the angiotensin II type 1 receptor antagonist candesartan cilexetil in patients receiving chronic haemodialysis.

Design: The study was a double-blind, randomised, placebo-controlled, dose-escalation study.

Prevention of clot formation during haemodialysis using the direct thrombin inhibitor melagatran in patients with chronic uraemia.

Background: This study assessed the feasibility of replacing intravenous (i.v.) dalteparin with the direct thrombin inhibitor (DTI) melagatran administered via dialysis fluid in patients undergoing haemodialysis, and also examined the pharmacokinetics of melagatran with and without dialysis.

Influence of severe renal impairment on the pharmacokinetics and pharmacodynamics of oral ximelagatran and subcutaneous melagatran.

Background: Ximelagatran is an oral direct thrombin inhibitor currently in clinical development as an anticoagulant for the prevention and treatment of thromboembolic disease. After oral administration, ximelagatran is rapidly absorbed and bioconverted to its active form, melagatran.

Objective: To investigate the effect of severe renal impairment on the pharmacokinetics and pharmacodynamics of melagatran following administration of subcutaneous melagatran and oral ximelagatran.

Dialysis modalities and dyslipidemia.

Progressive renal failure is accompanied by dyslipidemia, which is reflected in an abnormal apolipoprotein profile. It is characterized by increased concentrations of intact and partially metabolized triglyceride-rich apoB-containing lipoproteins. They occur preferentially in very-low density lipoprotein (VLDL) and low-density lipoprotein (LDL) as a result of impaired metabolism and clearance.

Alterations in lipoprotein composition in peritoneal dialysis patients.

Objective: Dyslipidemia is common among patients with end-stage renal disease, whether treated by hemodialysis (HD) or peritoneal dialysis (PD). To better understand the specific lipoprotein abnormalities in PD patients, we measured the lipid and apolipoprotein (Apo) composition of the four major classes of plasma lipoproteins in PD patients, HD patients, and healthy control subjects: very low density (VLDL), intermediate density (IDL), low density (LDL), and high density lipoproteins (HDL).

Design: Fasting plasma samples were obtained from 15 nondiabetic PD patients, 15 nondiabetic HD patients, and 16 healthy control subjects, all from a cross section of patients and subjects in the region of Göteborg, Sweden.

Lipoprotein particle abnormalities and the impaired lipolysis in renal insufficiency.

Background: Increased concentrations of very low- (VLDL) and intermediate-density (IDL) lipoproteins in chronic renal failure (CRF) are thought to result from a defect(s) in degradation of plasma triglyceride (TG)-rich lipoproteins. The purpose of this study was to identify lipoprotein abnormalities associated with the reduced lipolytic rate constant, k1, of combined VLDL and IDL substrate from renal patients and asymptomatic controls.

Methods: The VLDL + IDL were isolated from 18 predialytic patients (CRF-I), 8 patients on hemodialysis (CRF-II) and 10 asymptomatic controls.