Metformin therapy in patients with chronic kidney disease

Metformin therapy is limited in patients with chronic kidney disease (CKD) due to the potential risk of lactic acidosis. This open‐label observational study investigated metformin and lactate concentrations in patients with CKD (n = 22; creatinine clearances 15–40 ml/min) and in two dialysed patient...

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Bibliographic Details
Published in:Diabetes, obesity & metabolism obesity & metabolism, 2012-10, Vol.14 (10), p.963-965
Main Authors: Duong, J. K., Roberts, D. M., Furlong, T. J., Kumar, S. S., Greenfield, J. R., Kirkpatrick, C. M., Graham, G. G., Williams, K. M., Day, R. O.
Format: Article
Language:English
Subjects:
Acidosis
Acidosis, Lactic - blood
Acidosis, Lactic - chemically induced
Acidosis, Lactic - etiology
Aged
Aged, 80 and over
Antidiabetics
Creatinine
Diabetes
Diabetes mellitus
Diabetes Mellitus, Type 2 - blood
Diabetes Mellitus, Type 2 - complications
Diabetes Mellitus, Type 2 - drug therapy
diabetic nephropathy
Dose-Response Relationship, Drug
Drug Administration Schedule
Female
Humans
Hypoglycemic Agents - administration & dosage
Hypoglycemic Agents - adverse effects
Kidney
Kidney diseases
Lactic acid
Lactic Acid - blood
Lactic acidosis
Male
Metabolism
Metformin
Metformin - administration & dosage
Metformin - adverse effects
Middle Aged
Obesity
pharmacokinetics
pharmacology
Renal Dialysis
Renal function
Renal Insufficiency, Chronic - blood
Renal Insufficiency, Chronic - complications
Renal Insufficiency, Chronic - therapy
Risk Factors
type 2 diabetes
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Summary:Metformin therapy is limited in patients with chronic kidney disease (CKD) due to the potential risk of lactic acidosis. This open‐label observational study investigated metformin and lactate concentrations in patients with CKD (n = 22; creatinine clearances 15–40 ml/min) and in two dialysed patients. Patients were prescribed a range of metformin doses (250–2000 mg daily) and metformin concentrations were compared with data from healthy subjects (scaled to 1500 mg twice daily). A subset of patients (n = 7) was controlled on low doses of metformin (250 or 500 mg daily). No correlation between metformin and lactate concentrations was observed. Three patients had high lactate concentrations (>2.7 mmol/l) and two had high metformin concentrations (3–5 mg/l), but none had any symptoms of lactic acidosis. Reducing metformin dosage and monitoring metformin concentrations will allow the safe use of metformin in CKD, provided that renal function is stable.
ISSN:1462-8902
1463-1326
DOI:10.1111/j.1463-1326.2012.01617.x