According to the results of a retrospective observational study, the majority of pharmacotherapies used for the treatment of bipolar disorder (BD) are associated with some risk of kidney disorder (KD).
The aim of the study was to evaluate and summarize the real-world risk of newly observed KDs associated with both monotherapy and combination therapy used in the treatment of bipolar disorder. “This retrospective observational study used the IBM MarketScan database to analyze data on 591,052 adults with bipolar disorder without prior nephropathy, for onset of KDs (of “moderate” or “high” severity) following psychopharmacotherapy (lithium, mood stabilizing anticonvulsants [MSAs], antipsychotics, antidepressants), or “no drug,” the authors explained. A total of 71 regimens (18 monotherapies, 53 combination therapies) were analyzed. Hazard ratios (HRs) of each therapy compared to “no drug” were estimated.
New onset KDs were observed in 14,713 patients. “Both of our regression models show, that most of the studied pharmacotherapies were associated with significantly increased risk of KDs over the drug-free regimen,” report the authors. “All” KD HR estimates were found to range between 0.86 and 2.66 while “severe” KD HR estimates ranged between 0.87 and 5.30. Additionally, it was found that more complex drug combinations were associated with higher HRs.
The study authors also analyzed the risk of KDs associated with various bipolar disorder pharmacotherapy classes. Data analysis found that drug combinations containing lithium, MSAs, or antipsychotics were associated with a higher risk compared to a “no drug” regimen (P <.05). “The risk for ‘all’ and ‘severe’ KDs was highest respectively on monoamine oxidase inhibitors (MAOIs) (HR = 2.66, P =5.73 × 10−5), and a lithium-containing 4-class combination (HR = 5.30, P =2.46 × 10−9),” the study authors stated. Additionally, the HR for ‘severe’ KDs for lithium monotherapy was found to be 1.82 (P = 4.73 × 10−17).
As for monotherapy with antidepressants such as selective serotonin reuptake inhibitors, selective-norepinephrine reuptake inhibitors, and noradrenergic and specific serotonergic antidepressants, the risk of KDs was not found to be statistically significant when compared with “no drug.”
“The findings support literature concerns about lithium nephrotoxicity and highlight the potential risks of MAOIs, MSAs, antipsychotics and psychotropic polypharmacy,” conclude the authors. Based on the study results, the authors encourage healthcare providers to consider monitoring renal function in patients with bipolar disorder, especially those receiving medications or drug combinations with known KD risk.
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