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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. The follow-up time was 10 years after completion of 1-year treatment. The data were collected from Sahlgrenska University Hospital's laboratory database. Results: In all, 2169 patients were included: 623 in Cohort 1 (started lithium during 1980s), 874 in Cohort 2 (1990s) and 672 in Cohort 3 (2000s). Compliance with lithium monitoring guidelines improved, and mean serum lithium decreased, through the cohorts. In all, 22 patients developed CKD4 during follow-up. The time to CKD4 was the same in all three cohorts (overall: 10.96 years, 95% confidence interval: 10.94–11 years). Age and serum creatinine concentration at start were significant risk factors, while sex had no prognostic value. After adjusting for the significant covariates, there was no statistically significant difference in the hazard for CKD4 between the three cohorts. Conclusion: The risk for severe renal damage during the first decade of long-term lithium is low, but has not changed over time. Our data suggest that improved compliance with lithium guidelines is not reflected in less risk for severe renal damage. [ABSTRACT FROM AUTHOR]

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. We compared the risk of developing CKD 4–5 in two patient cohorts: an exposed cohort of 83 patients who had high serum creatinine prior to start of lithium and a reference cohort of 83 patients with normal serum creatinine, matched by gender, duration of lithium treatment and age at the start of lithium treatment. The patients' medical charts were reviewed and the Swedish Renal Registry was used to identify patients with renal replacement therapy. Results: There were no significant differences between the exposed and reference cohorts with respect to our matching criteria. Almost half the patients in the exposed cohort versus only 10% of the reference patients progressed to CKD 4–5 (HR 6.7, 95%CI 3.1–14.3, p < 0.001) during a mean observation time of more than 10 years. The progressors were older at the start of lithium treatment and were characterised by a higher burden of comorbid somatic diseases, in particular cardiovascular diseases. Conclusions: Compromised renal function prior to initiating lithium treatment increases the risk of developing severe renal impairment. Monitoring of renal function should include somatic comorbidity among older patients. [ABSTRACT FROM AUTHOR]

Tissue advanced glycation end products (AGEs) are a measure of cumulative metabolic and oxidative stress and cytokine‐driven inflammatory reactions. AGEs are thought to contribute to the cardiovascular complications of hemodialysis (HD) patients. Skin autofluorescence (SAF) is related to the tissue accumulation of AGEs and rises with age. SAF is one of the strongest prognostic markers of mortality in these patients. The content of AGEs is high in barbecue food. Due to the location in northern Sweden, there is a short intense barbecue season between June and August. The aim of this study was to investigate if seasonal variations in SAF exist in HD patients, especially during the barbecue season. SAF was measured noninvasively with an AGE Reader in 34 HD‐patients (15 of those with diabetes mellitus, DM). Each time the median of three measures were used. Skin‐AF was measured before and after each one HD at the end of February and May in 31 patients (22 men/9 women); the end of May and August in 28 (20 m/8 w); the end of August and March in 25 (19 m/6 w). Paired statistical analyses were performed during all four periods (n = 23, 17 m/6 w); as was HbA1c of those with DM. There was at a median 5.6% increase in skin‐AF during the winter period (February–May, P = 0.004) and a 10.6% decrease in the skin‐AF during the summer (May–August, P < 0.001). HbA1c in the DM rose during the summer (P = 0.013). In conclusion, skin‐AF decreased significantly during the summer. Future studies should look for favorable factors that prevent skin‐AF and subsequently cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Caution is generally advised when starting lithium treatment in patients with impaired renal function. We aimed to study the risk of developing severe chronic kidney disease (CKD) among patients with impaired renal function treated with lithium. The risk of developing severe CKD was calculated from a register-based cohort of 83 cases with already elevated serum creatinine at lithium start compared to 83 controls matched by age, gender and duration of lithium treatment, with normal serum creatinine at lithium start. The definition of severe CKD was reaching at least stage 4 i.e. an estimated glomerular filtration rate (eGFR) of <30 ml/min/m2. The data was collected from Sahlgrenska University Hospital's laboratory database and patient charts. The rate of severe CKD at 10-years follow-up was 48% (95%-confidence interval (95%-CI): 34–59%) for the cases and 11% (95%-CI: 2–18%) for the controls. Age and sex-adjusted Hazard Ratio was 6.7 for the whole follow-up (95%-CI 3.1–14.3, p < 0.001), considering the competing risk of death. The progression towards severe CKD was continuous over 20 years. Higher age at start of lithium, burden of somatic comorbidities and use of lithium before 1980 were associated with progression to severe CKD among cases. Impaired renal function prior to initiating lithium treatment increases substantially the risk of developing severe CKD. Careful consideration of the benefits and risks of lithium therapy is strongly recommended. In patients with laboratory signs of renal impairment and prophylactic lithium treatment, associated somatic comorbidities should be closely monitored. [ABSTRACT FROM AUTHOR]

Tissue advanced glycation end products (AGEs) are a measure of cumulative metabolic and oxidative stress and cytokine-driven inflammatory reactions. AGEs are thought to contribute to the cardiovascular complications of hemodialysis (HD) patients. Skin autofluorescence (SAF) is related to the tissue accumulation of AGEs and rises with age. SAF is one of the strongest prognostic markers of mortality in these patients. The content of AGEs is high in barbecue food. Due to the location in northern Sweden, there is a short intense barbecue season between June and August. The aim of this study was to investigate if seasonal variations in SAF exist in HD patients, especially during the barbecue season. SAF was measured noninvasively with an AGE Reader in 34 HD-patients (15 of those with diabetes mellitus, DM). Each time the median of three measures were used. Skin-AF was measured before and after each one HD at the end of February and May in 31 patients (22 men/9 women); the end of May and August in 28 (20 m/8 w); the end of August and March in 25 (19 m/6 w). Paired statistical analyses were performed during all four periods (n = 23, 17 m/6 w); as was HbA1c of those with DM. There was at a median 5.6% increase in skin-AF during the winter period (February-May, P = 0.004) and a 10.6% decrease in the skin-AF during the summer (May-August, P < 0.001). HbA1c in the DM rose during the summer (P = 0.013). In conclusion, skin-AF decreased significantly during the summer. Future studies should look for favorable factors that prevent skin-AF and subsequently cardiovascular diseases., (© 2018 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)