Chronic renal failure in lithium‐using geriatric patients: effects of lithium continuation versus discontinuation—a 60‐month retrospective study
Bibliographic record
Abstract
OBJECTIVE: Lithium remains an important treatment in bipolar disorder. Although lithium is often discontinued because of signs of renal failure, it is unclear if this alters the course of renal function in the majority of patients. We hypothesize that in geriatric patients with chronic renal failure (CRF), who have a high burden of medical illness, lithium continuation does not significantly impact renal function (glomerular filtration rate (eGFR)). METHODS: We conducted a retrospective study of tertiary-care geriatric psychiatry outpatients with a history of lithium use and evidence of CRF (eGFR ≤ 60 ml/min/1.73 m2 on ≥ 2 occasions in ≥ 3 months). The 27 patients who met these criteria were divided into lithium 'continuers' (continued use ≥ 2 years following CRF) and 'discontinuers'. Mean eGFR and creatinine were followed at 21 and 60 months after developing CRF. RESULTS: Mean serum eGFR and creatinine were not significantly different between groups at any time during follow-up. When comparing renal function at 60 months to baseline, a trend towards increased creatinine was seen in continuers (p = 0.06) but not in discontinuers. Changes in eGFR in continuers and discontinuers after 60 months did not achieve statistical significance (p = 0.35 and 0.98). However, clinically important decreases in eGFR occurred in the majority of continuers but in none of the discontinuers. CONCLUSIONS: There was a trend towards declining renal function in lithium continuers at 60-month follow-up. Future prospective longitudinal studies will be needed to confirm our findings. We suggest vigilance and close monitoring of renal function when continuing CRF patients on lithium for extended periods.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".