For patients with severe bipolar disorder who either cannot tolerate or do not respond to other mood stabilizers, lithium is an acceptable option even if the patient has renal disease requiring hemodialysis. Nonpharmacologic interventions are not sufficient on their own to manage bipolar disorder (option C). As lithium is completely removed by dialysis, doses on hemodialysis days should be given just after dialysis (option B). There is no need to hold lithium on these days and this should be avoided in order to maintain mood stability (option D). Lithium levels should be closely monitored in any patient with renal disease. For hemodialysis patients, it is best to check levels 2-3 hours following dialysis sessions (rather than immediately following a session) as it takes approximately this amount of time for lithium to re-equilibrate from tissue stores following the dialysis procedure (option A).

Publication reference : Levenson, James L. "Renal Disease." Textbook of Psychosomatic Medicine and Consultation-Liaison Psychiatry, 3rd Ed, American Psychiatric Association Publishing, 2019, pp. 571-91.