1
|
Bosi A, Laura C, Fu E, Runesson B, M. Clase C, Chang Z, Landen M, Elinder CG, Jesus Carrero J, Bellocco R. MO502: Use of Lithium, Valproate and the Risk of Acute or Chronic Kidney Disease: An Observational Study From Routine Care Data. Nephrol Dial Transplant 2022. [DOI: 10.1093/ndt/gfac071.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND AND AIMS
Lithium is an established treatment for bipolar disorder and treatment-resistant depression. Despite awareness of potential kidney damage, there is a lack of research evidence to inform on the existence and magnitude of the risk. Observational studies to date show conflicting findings, possibly explained by inadequate control populations, prevalent user bias and a lack of information on kidney function or serum lithium levels.
METHOD
We conducted a cohort study to compare kidney outcomes in adults who started lithium or valproate therapy in Stockholm, Sweden, during 2007–18. Within lithium users, we also compared outcomes by average serum lithium concentrations during the first year of therapy. Kidney outcomes were CKD progression (composite of >30% eGFR decline and kidney failure) and AKI (by diagnosis or KDIGO transient creatinine elevations). Propensity score weighted Cox regression was used to estimate hazard ratios with [95% confidence intervals (95% CI)] and balance 46 identified confounders. Complete collection of repeated dispensations at Swedish pharmacies allowed modelling of the time-dependent risk associated with cumulative lithium exposure. Sensitivity analyses included restricting to patients with a diagnosis of bipolar disorder, apply a 1-year lag, use of alternative weighting methods and evaluation of eGFR monitoring rates to ascertain surveillance bias between groups.
RESULTS
We included 16 645 individuals, of whom 5308 initiated lithium and 5638 valproate therapy. Their median age was 45 years (57% women) and median eGFR was 99 mL/min/1.73 m2. A total of 179 CKD progression events and 234 AKI were identified during a median of follow-up of 4.3 and 4.2 years, respectively. After propensity score weighting, the adjusted hazard ratio for the risk of CKD progression was 1.12 (95% CI 0.86–1.47) and for AKI 0.88 (95% CI 0.7–1.09). There was a weak, non-statistically significant association between cumulative exposure to lithium and the risk of CKD progression that was not observed for cumulative use of valproate. Results were consistent among patients with a bipolar disorder diagnosis and robust to 1-year lag or alternative weighing methods. A total of 3913 lithium users were on therapy for at least one year and underwent routine serum lithium monitoring. Compared with patients with average serum lithium levels <1.0 mEq/L, those with serum lithium ≥1.0 mEq/L (n = 270) were at a higher risk of both CKD progression (HR: 2.18; 1.28–3.71) and AKI (HR: 1.37; 0.81–2.34).
CONCLUSION
In this analysis of patients from routine clinical practice, the risk of kidney outcomes associated with lithium therapy did not differ from that of valproate. Modest risk magnitudes need to be offset with the effectiveness and anti-suicidal benefits of lithium. However, elevated serum lithium levels strongly predicting kidney risk, emphasizing the need for close monitoring and lithium dose-adjustment.
Collapse
Affiliation(s)
- Alessandro Bosi
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Ceriani Laura
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milano, Italy
| | - Edouard Fu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Björn Runesson
- Department of Public Health and Clinical Medicine, Umeå Universitet, Umeå, Sweden
| | - Catherine M. Clase
- Department of Health Research Methods, Evidence & Impact, McMaster Unisversity, Hamilton, Canada
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Mikael Landen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Department of Neuroscience and Physiology, Gothenburg University, Gothenburg, Sweden
| | - Carl-Gustaf Elinder
- Clinical Science, Intervention and Technology, Karolinska Institutet, Huddinge, Sweden
| | - Juan Jesus Carrero
- Clinical Science, Intervention and Technology, Karolinska Institutet, Huddinge, Sweden
| | - Rino Bellocco
- Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milano, Italy
- Clinical Science, Intervention and Technology, Karolinska Institutet, Huddinge, Sweden
| |
Collapse
|
2
|
Spinella A, Toss A, Isca C, Vacchi C, Iannone A, Magnani L, Castrignanò P, De Pinto M, Laura C, Maiorana A, Salvarani C, Dominici M, Giuggioli D. AB0425 CLINICAL AND PATHOLOGICAL FEATURES OF BREAST CANCER IN PATIENTS WITH SYSTEMIC SCLEROSIS: PRELIMINARY DATA FROM THE SCLERO-BREAST STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Systemic Sclerosis (SSc) is a rare and life-threatening connective tissue disease characterized by vascular dysfunction, specific autoimmune abnormalities and fibrosis of the skin and internal organs. Previous studies have shown a 1.5-fold increase in cancer risk in SSc patients compared with the general population, including breast cancer (BC). The relationship between BC and SSc has long been discussed but past research has been contradictory and inconclusive on this topic.Objectives:The aim of our project was to analyze clinical and pathological characteristics of BC developed by SSc subjects and possible correlations with scleroderma features. Here we present the preliminary data from the Sclero-Breast study.Methods:Our observational retrospective multicenter study enrolled 33 SSc women with a personal history of BC identified at two Rheumatology/SSc Units in the north of Italy between January 2017 and December 2019 (lc/dcSSc 23/9, 1 unknown; mean age at SSc onset 57 years, range 32-73). All patients underwent general and instrumental assessment: smoking habits; presence of skin ulcers, calcinosis, teleangectasia; presence of gastro-intestinal and kidney involvement; interstitial lung disease (at HR-CT); pulmonary function tests; ECG abnormalities; echocardiographic assessment of pulmonary arterial hypertension (PAH); videocapillaroscopic pattern; autoantibody profile; exposure to immunosuppressive and vasoactive therapies; status at last follow-up evaluation and cause of death. Clinical and pathological characteristics of BC were also evaluated: age at diagnosis; menopausal status; histotype; hormone receptor status; MIB1, HER2 expression; clinical and pathological stage at diagnosis; metastatic sites; type of loco-regional treatment (surgery and radiotherapy); type of systemic treatment (neoadjuvant/adjuvant chemotherapy and endocrine treatment); other cancers and time from diagnosis of the first disorder to the second one.Results:A total of 54.5% of subjects developed BC before SSc (median interval of 5 years), whereas 45.5% of patients developed BC after SSc (median delay of 8 years). 54.5% of patients showed interstitial lung disease and the cause of death of the 6 deceased subjects was PAH. A significant association (p<0.05) was observed between the use of immunosuppressive therapy and diffuse skin extension, negative ACA, positive Anti-Scl-70 and interstitial lung disease, but not with BC status. 93.1% of patients were diagnosed with an early-stage tumor, 70.8% of invasive carcinomas with a low MIB-1, 8.3% with a tubular histotype, while 42.8% presented with a Luminal A-like tumor. 66.6% underwent breast conserving surgery and 55.5% RT after surgery. 40% of patients developed interstitial lung disease after RT and 20% dcSSc.Conclusion:According to our preliminary data, SSc patients developed BC at good prognosis, suggesting a de-escalation strategy of cancer therapies. On these grounds, a proper screening is mandatory in order to allow for early cancer detection in SSc patients. Further investigations on larger numbers of patients are needed. First of all, they would further clarify the intriguing relationship between BC and SSc. Secondly, they would help to explore the common biological and molecular pathways at the basis of these two disorders, with the aim to improve BC diagnosis and prognosis and to personalize oncological targeted treatments in this subset of fragile patients.Disclosure of Interests:None declared
Collapse
|
4
|
Linton L, Laura C, Tessa S. MUSCULOSKELETAL TESTING OF ORIENTEERS DURING PRE-PARTICIPATION EVALUATION AND ASSOCIATIONS WITH LIMB DOMINANCE AND INJURY HISTORY. Br J Sports Med 2014. [DOI: 10.1136/bjsports-2014-093494.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
5
|
Felin JE, Mayo JL, Laura C. Nuclear Localization of BMP2. FASEB J 2006. [DOI: 10.1096/fasebj.20.4.a534-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jenny E. Felin
- Bridgewater.Brigham Young UniversityDepartment of Microbiology and Molecular BiologyProvoUT84602
| | - Jaime L. Mayo
- Bridgewater.Brigham Young UniversityDepartment of Microbiology and Molecular BiologyProvoUT84602
| | - C Laura
- Bridgewater.Brigham Young UniversityDepartment of Microbiology and Molecular BiologyProvoUT84602
| |
Collapse
|
6
|
Giralt J, Aranzazu E, Manuel D, Laura C, Elorza-Ricart J, Velez D, Valero G, Benavente S, Armengol M, de Torres I. Prognostic significance of epidermal growth factor receptor (EGFR) in patients with rectal cancer treated with preoperative radiotherapy: a GICOR study. Int J Radiat Oncol Biol Phys 2002. [DOI: 10.1016/s0360-3016(02)03227-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
7
|
Abstract
By means of quantitative receptor autoradiography, the modifications of dopamine (DA) receptors in selected target regions of A9 and A10 DA neurons were studied after chronic apomorphine treatment, at a dosage able to induce behavioral changes that are claimed to be due to the activation of the target areas of A9 neurons. An increase in [3H]spiperone binding sites (cold (+)-butaclamol) was observed in the dorsal and ventrolateral striatum, receiving fibers from A9 neurons, while there were no changes in the ventromedial and ventrocentral striatum, in the nucleus accumbens and in the cerebral cortex receiving fibers from A10 neurons. Our results suggest that the anatomical division of the DA target regions corresponds with a functional one.
Collapse
|