We would like to thank Professor Ott and Professor Werneke for their helpful comments [1]. Importantly, the mortality rate related to lithium poisoning is zero in the study by Ott et al. [2]. Furthermore, lithium is freely filtered in the glomerulus and largely reabsorbed in the proximal tubule [3].
We agree that hemodialysis is an important procedure for treating patients with severe lithium poisoning as it increases lithium clearance. Nevertheless, the published hemodialysis rates for lithium poisoning vary widely, from 1.5% to 60.8% [4]. This is because there are some risks associated with emergency hemodialysis. Another explanation is that emergency hemodialysis intervention accessibility varies across different hospitals. Complications during femoral vein catheterization in emergency hemodialysis comprise infection, thrombosis, arterial puncture, groin hematoma, etc. [5]. Furthermore, complications of hemodialysis include heart arrhythmias, intradialytic hypotension or hypertension, dialysis disequilibrium syndrome, seizure, etc. Interestingly, Buckley et al. [6] commented that the hemodialysis criteria of the EXtracorporeal TReatments In Poisoning (EXTRIP) workgroup [7] were too broad, exposing lithium patients who may have recovered with conservative treatment to the risks of hemodialysis and incurring additional costs. Through an integrated assessment of the pattern of poisoning, serum lithium level, renal function and clinical presentation of toxicity, they were able to reduce the need of hemodialysis but still identify the patients who benefit from it. In summary, our group advocates that hemodialysis treatment for lithium poisoning should be patient-tailored, and there is no ideal universal indication for all lithium patients.
Author Contributions
Writing—original draft preparation Y.-H.L.; writing—review and editing T.-H.Y. All authors have read and agreed to the published version of the manuscript.
Conflicts of Interest
The authors declare no conflict of interest.
Footnotes
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.
References
- 1.Ott M., Werneke U. Comment on Liu et al. Hemodialysis Treatment for Patients with Lithium Poisoning. Int. J. Environ. Res. Public Health 2022, 19, 10044. Int. J. Environ. Res. Public Health. 2023;20:5843. doi: 10.3390/ijerph20105843. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Ott M., Stegmayr B., Renberg E.S., Werneke U. Lithium intoxication: Incidence, clinical course and renal function—A population-based retrospective cohort study. J. Psychopharmacol. 2016;30:1008–1019. doi: 10.1177/0269881116652577. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Alsady M., Baumgarten R., Deen P.M., de Groot T. Lithium in the Kidney: Friend and Foe? J. Am. Soc. Nephrol. 2016;27:1587–1595. doi: 10.1681/ASN.2015080907. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Liu Y.-H., Tsai K.-F., Hsu P.-C., Hsieh M.-H., Fu J.-F., Wang I.-K., Liu S.-H., Weng C.-H., Huang W.-H., Hsu C.-W., et al. Hemodialysis Treatment for Patients with Lithium Poisoning. Int. J. Environ. Res. Public Health. 2022;19:10044. doi: 10.3390/ijerph191610044. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.El Minshawy O., El Aziz T.A., El Ghani H.A. Evaluation of Vascular Access Complications in Acute and Chronic Hemodialysis. J. Vasc. Access. 2004;5:76–82. doi: 10.1177/112972980400500206. [DOI] [PubMed] [Google Scholar]
- 6.Buckley N.A., Cheng S., Isoardi K., Chiew A.L., Siu W., Vecellio E., Chan B.S. Haemodialysis for lithium poisoning: Translating EXTRIP recommendations into practical guidelines. Br. J. Clin. Pharmacol. 2020;86:999–1006. doi: 10.1111/bcp.14212. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Decker B.S., Goldfarb D.S., Dargan P.I., Friesen M., Gosselin S., Hoffman R.S., Lavergne V., Nolin T.D., Ghannoum M. Extracorporeal Treatment for Lithium Poisoning: Systematic review and recommendations from the extrip workgroup. Clin. J. Am. Soc. Nephrol. 2015;10:875–887. doi: 10.2215/CJN.10021014. [DOI] [PMC free article] [PubMed] [Google Scholar]