did a 2022 lancet psychiatry study find no extra kidney decline in the first decade on lithium?
“they showed that really for that first decade, patients on lithium actually didn't have worse results than people who just had bipolar or really the general population.”
a guest, a psychiatrist said on PsychEd: Educational Psychiatry Podcast, 2026-11-01, at 34:15. hear it in context → the speaker cited: Franson et al., Lancet Psychiatry 2022.
the episode: PsychEd Case Rounds 1 with Dr. David Gratzer (at 34:15). we link the show's own page; we do not re-host audio.
first, the part that holds
the study is real and says what the speaker said it says: in the 2022 lancet psychiatry paper from northern sweden, kidney function in people on lithium for up to 10 years did not decline significantly faster than in people with bipolar disorder who never took lithium or in the general population. the steeper decline showed up after more than 10 years.
what we found when we went and looked
the paper is Fransson et al., lancet psychiatry 2022;9(10):804-814. the speaker said "Franson", but the first author's name is spelled Fransson. it compared 785 people with bipolar or schizoaffective disorder (the LiSIE cohort) with 1,549 people from the general population (the MONICA cohort). it grouped patients by how long they had taken lithium: never or under 1 year, 1-5 years, more than 5 to 10 years, and more than 10 years. the abstract reports that with more than 10 years of lithium, decline in eGFR (a blood-test estimate of kidney filtering) "steepened significantly compared to all other groups" (p<0.0001). a 2023 review in the international journal of bipolar disorders describes the same paper this way: decline in lithium-treated patients "differed from a control population only after ten years of lithium exposure." the same abstract also reports that lithium added 0.54 mL/min/1.73 m² of eGFR decline per year of treatment. it found lithium nephropathy (kidney damage from lithium) was the most common cause of moderate-to-severe chronic kidney disease, and that people's kidney responses to lithium varied widely.
assertion by assertion
| assertion | verdict | what the record says |
|---|---|---|
| a 2022 lancet psychiatry study with a first author named Franson (spelled Fransson) looked at kidney function in people on lithium | confirmed | Fransson F, Werneke U, et al. Lancet Psychiatry 2022 Oct;9(10):804-814 (PMID 36108668). it compared 785 LiSIE patients with 1,549 MONICA general-population participants. the speaker's spelling of the name is a minor slip. [1][2] |
| for the first decade, people on lithium did not do worse than people with bipolar disorder who never took lithium, or than the general population | confirmed | with more than 10 years of lithium, decline was significantly steeper than in all other groups (p<0.0001). the review calls the difference from controls visible 'only after ten years of lithium exposure.' one limit: the shorter-exposure groups showed no significant difference, which is not the same as showing their decline was identical. we read the abstract and the review's summary, not the paper's full subgroup tables. [1][2] |
| the outcome was renal function | confirmed | the primary outcome was the rate of age-associated decline in creatinine-based eGFR. that is a rate of change in an estimated measure, not a direct measure of kidney filtering at a single point in time. [1] |
| popular framing: the study shows lithium has no kidney effect in the first 10 years | overstated | the same abstract reports that lithium added 0.54 mL/min/1.73 m² of decline per year of treatment (p<0.0001), counted across all treated patients. it also reports wide differences between people. a 2025 follow-up by the same group found that eGFR decline slowed by about 1.55 mL/min/1.73 m² per year after people stopped lithium. the 10-year threshold describes group averages, not a safe window for every individual. [1][3] |
both directions
for the speaker: the abstract stratifies patients by length of lithium use and reports that decline was significantly steeper only in the group with more than 10 years of exposure. an independent 2023 review reads the paper the same way: the difference from controls appears "only after ten years of lithium exposure." the abstract also reports that, once lithium duration was accounted for, eGFR declined at the same baseline rate (0.57 mL/min/1.73 m² per year) in people with bipolar disorder and in the general population. that supports the speaker's comparison with both groups.
against: the paper's overall message is not reassurance. the authors attribute the steeper decline in bipolar patients to lithium, estimate that lithium adds 0.54 mL/min/1.73 m² of decline per year of treatment, and name lithium nephropathy as the leading cause of moderate-to-severe chronic kidney disease in the cohort. they also stress that people vary widely, so some individuals may decline faster within the first decade. the same group's 2025 follow-up found that decline largely flattened after lithium was discontinued, which points to an ongoing effect while people are on it. not finding a significant difference in a shorter-exposure subgroup is not proof that there is no difference.
what this cannot say
the study is cross-sectional and observational. it was done in one region of northern sweden, and its general-population comparison group was aged 25-74, so a causal reading and generalization beyond that population are limited. eGFR is estimated from blood creatinine, not measured directly. the publisher's full text was blocked for us, so we read the pubmed abstract and a peer-reviewed review that summarizes the duration finding, not the paper's subgroup tables or confidence intervals. we cannot say how close the 5-10 year group came to statistical significance.
sources, each one fetched and read
- Fransson F, Werneke U, et al. Kidney function in patients with bipolar disorder with and without lithium treatment compared with the general population in northern Sweden: results from the LiSIE and MONICA cohorts. Lancet Psychiatry 2022;9(10):804-814. PMID 36108668 What we read there: LiSIE n=785, MONICA n=1,549. adjusted for lithium duration, eGFR declined at 0.57 mL/min/1.73 m² per year in both the patient and reference groups. lithium added 0.54 mL/min/1.73 m² per year of treatment (p<0.0001). after more than 10 years of treatment, decline was significantly steeper than in all other groups (p<0.0001). Fetched 2026-11-01 (HTTP 200). https://pubmed.ncbi.nlm.nih.gov/36108668/
- Gitlin M, Bauer M. Key questions on the long term renal effects of lithium: a review of pertinent data. International Journal of Bipolar Disorders 2023 What we read there: "One recent study demonstrated that the average annual decline in eGFR in lithium treated patients differed from a control population only after ten years of lithium exposure" (citing Fransson et al. 2022). Fetched 2026-11-01 (HTTP 200). https://pmc.ncbi.nlm.nih.gov/articles/PMC10654310/
- Fransson F, et al. Kidney function decline improves after lithium discontinuation. Journal of Internal Medicine 2025 What we read there: in 168 people, eGFR decline was -1.58 mL/min/1.73 m² per year before discontinuation and -0.023 after (p<0.0001). in the 48 who restarted lithium, decline returned to -1.71. Fetched 2026-11-01 (HTTP 200). https://pmc.ncbi.nlm.nih.gov/articles/PMC11846072/
speakers are described by role, not named. one sentence is quoted under fair use, with attribution and a link to the original at the timestamp; we do not re-host audio or video. nothing on this page is a reason to start, stop or change a medication. if you have the file behind anything marked unverifiable, the research board is where people can answer. adam