Lithium and Dialysis, Part VI

Author: Natalia A. Beiser

I have been on dialysis since July 2021 and continue to take Lithium, which in some patients causes decreased kidney function. However, I continue to be prescribed Lithium because it is the only proven medicine to curb my personal experience with bipolar disorder.

What readers should know about my experience with Lithium and dialysis is somewhat unconventional, because I lost a kidney to renal cell carcinoma while also having lithium induced nephropathy.  I now have 8% kidney function.

I was told that taking Lithium on dialysis would be tricky, and it is.  For many years, I took a pretty standard dose and the dose needed tweaked as my kidney function continued to drop.

Persons taking Lithium generally have a “sweet spot” in their serum levels.  Mine always was between 0.7 and 0.8.  If it was lower than 0.7, I was likely to become manic.  If it was above 0.8, I would display tremors.  Everyone has a different tolerance, and I am by no means saying that my “sweet spot” is the same as other Lithium patients.

I am now trying to find my dialysis patient on Lithium “sweet spot,” which has proven to be challenging.  My psychiatrist and I are guessing that I need to be at a 0.5.  It has been running significantly lower than that, and I have been experiencing some mild hypomania.  In my case, this causes me to exhibit bad judgement in spending money and misplacing and/or losing it.

I have an order at the hospital laboratory where I can have my levels checked as regularly as I feel is warranted.  No one likes to go to the lab, and I probably don’t go enough.  However, it is comforting to know that going there if I am experiencing symptoms, including toxicity, is a simple option.

I never thought that I would so openly talk about this, but I am so thankful that I can still urinate.  At some point, most dialysis patients lose their ability to do so and the dialysis machine must completely meet that need of removing the waste.

Right now, the dialysis machine does not pull much fluid off of me.  For the most part, the machine cleans my blood, as my kidneys can no longer do that.  Before the dialysis machine, I was chronically fatigued in a way that most people cannot comprehend.  I was sleeping in excess of twelve hours a day.  I also had an odor that only I could smell (very common in kidney failure patients) that soap and water could not eliminate.  Also, I itched and swelled.  Right before starting dialysis it became difficult to walk because I was puffy.

I have a three times a week prescription, where I sit for three hours and fifteen minutes on the machine, where the arm that is being accessed through a surgical port must be completely still.  This is difficult!  The technicians can remove you from the machine so that you can use the restroom, but they do not encourage it.

In my experience, the dialysis technicians are fantastic.  They make a bad situation much better, and one can generally talk to them about anything.  One of the tech’s father’s lost his life due to kidney failure from Lithium, which makes us kindred spirits.

It is not advised to skip dialysis treatments.  Yesterday, I did.  I needed a mental health day.  The sun was shining for the first time in a while and it was hot outside.  I knew that I needed to experience this.  I went to the flower market and bought flowers for the yard.  I planted the flowers and cleaned the patio.   I may have regret playing dialysis hooky after my treatment tomorrow night.

Without Lithium and without that damned dialysis machine, I would not have been able to enjoy that day of hooky.  Also, without the countless number of people that keep me in their daily prayers, I would not be here, either.  To God be the glory.

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