Psychiatric Issues for Patients With Renal Disease

Excretion takes place through the GI tract and from the kidney to the bladder, and this latter avenue is obviously absent following renal failure.\n6 mg/dL indicate the need for nephrologist consultation * Individuals with serum creatinine concentrations of more than 2.5 mg/dL are at very high risk for progression to ESRD compared with individuals who have serum creatinine concentrations of less than 2.5 mg/dL. [...] in individuals with a creatinine clearance of 40 mL/min or less, there is a higher probability of continued renal deterioration at lithium discontinuation than in those who have a creatinine clearance of more than 40 mL/min * In patients with ESRD, a reduction in the lithium dose is required to prevent further toxicity, and a single dose of lithium is recommended after dialysis sessions; serum lithium levels obtained before and after dialysis are used to established appropriate dosing * In treating depression, SSRIs (eg, fluoxetine) appear to be generally safe and well-tolerated; venlafaxine levels markedly increase in patients with renal failure, which theoretically could intensify hypertension, a common morbidity in ESRD; tricyclic antidepressants are generally avoided because of concern for safety and tolerability; duloxetine levels increase markedly in patients who have ESRD compared with patients who have normal renal function, and this medication is not recommended Conclusions Sizable numbers of patients have compromised renal function, and it is highly likely that psychiatrists will need to collaborate with primary care providers and nephrologists when prescribing psychotropic medications.