Severe mental illness and chronic kidney disease: a cross-sectional study in the United Kingdom
Received 22 October 2017
Accepted for publication 18 December 2017
Published 16 April 2018 Volume 2018:10 Pages 421—429
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Justinn Cochran
Peer reviewer comments 4
Editor who approved publication: Professor Vera Ehrenstein
Masao Iwagami,1 Kathryn E Mansfield,1 Joseph F Hayes,2 Kate Walters,3 David PJ Osborn,2,4 Liam Smeeth,1 Dorothea Nitsch,1 Laurie A Tomlinson1
1Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; 2Division of Psychiatry, University College London, London, UK; 3Department of Primary Care and Population Health, University College London, London, UK; 4Camden and Islington NHS Foundation Trust, London, UK
Objective: We investigated the burden of chronic kidney disease (CKD) among patients with severe mental illness (SMI).
Methods: We identified patients with SMI among all those aged 25–74 registered in the UK Clinical Practice Research Datalink as on March 31, 2014. We compared the prevalence of CKD (two measurements of estimated glomerular filtration rate <60 mL/min/1.73 m2 for ≥3 months) and renal replacement therapy between patients with and without SMI. For patients with and without a history of lithium prescription separately, we used logistic regression to examine the association between SMI and CKD, adjusting for demographics, lifestyle characteristics, and known CKD risk factors.
Results: The CKD prevalence was 14.6% among patients with SMI and a history of lithium prescription (n = 4,295), 3.3% among patients with SMI and no history of lithium prescription (n = 24,101), and 2.1% among patients without SMI (n = 2,387,988; P < 0.001). The prevalence of renal replacement therapy was 0.23%, 0.15%, and 0.11%, respectively (P = 0.012). Compared to patients without SMI, the fully adjusted odds ratio for CKD was 6.49 (95% CI 5.84–7.21) for patients with SMI and a history of lithium prescription and 1.45 (95% CI 1.34–1.58) for patients with SMI and no history of lithium prescription. The higher prevalence of CKD in patients with SMI may, in part, be explained by more frequent blood testing as compared to the general population.
Conclusion: CKD is identified more commonly among patients with SMI than in the general population.
Keywords: severe mental illness, schizophrenia, bipolar disorder, chronic kidney disease, lithium
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