title: Metformin-associated risk of acute dialysis in patients with type 2 diabetes: A nationwide cohort study.
abstract: Recent guidelines governing anti-diabetic medications increasingly advocate metformin as first-line therapy in all patients with type 2 diabetes. However, metformin could be associated with increased risk of acute kidney injury (AKI), acute dialysis and lactate acidosis in marginal patients. In a retrospective nationwide cohort study, a total of 168 443 drug-naïve patients with type 2 diabetes ≥50 years, initiating treatment with either metformin or sulphonyl in Denmark between 2000 and 2012 were included in this study (70.7% initiated treatment with metformin); calculation of 1-year risk of acute dialysis was based on g-standardization of cause-specific Cox regression models for acute dialysis, end-stage renal disease and death. One-year risks of acute dialysis were 92.4 per 100 000 (95% CI, 67.1-121.3) and 142.7 per 100 000 (95% CI, 118.3-168.0) for sulphonylurea and metformin, respectively. The metformin-associated 1-year risk of acute dialysis was increased by 50.3 per 100 000 (95% CI, 7.9-88.6), corresponding to a risk ratio of 1.53 (95% CI, 1.06-2.23), and a number needed to harm of 1988, thus providing evidence of potential concerns pertaining to the increasing use of metformin.
authors.affiliation: Department of Cardiology, Gentofte Hospital, Copenhagen University, Hellerup, Denmark.|Department of Nephrology, Herlev Hospital, Copenhagen University, Herlev, Denmark.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Carlson
authors.affiliation: Department of Nephrology, Herlev Hospital, Copenhagen University, Herlev, Denmark.
authors.forename: Kristine
authors.initials: K
authors.lastname: Hommel
authors.affiliation: Department of Cardiology, Gentofte Hospital, Copenhagen University, Hellerup, Denmark.
authors.forename: Jonas B
authors.initials: JB
authors.lastname: Olesen
authors.affiliation: Department of Biostatistics, Copenhagen University, Copenhagen, Denmark.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Gerds
authors.affiliation: Department of Cardiology, Hvidovre Hospital, Copenhagen University, Hvidovre, Denmark.
authors.forename: Anne-Merete
authors.initials: AM
authors.lastname: Soja
authors.affiliation: Center for Diabetes Research, Gentofte Hospital, Copenhagen University, Hellerup, Denmark.
authors.forename: Tina
authors.initials: T
authors.lastname: Vilsbøll
authors.affiliation: Department of Nephrology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
authors.forename: Anne-Lise
authors.initials: AL
authors.lastname: Kamper
authors.affiliation: Institute of Health, Science and Technology, Aalborg University, Aalborg, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.affiliation: Department of Cardiology, Gentofte Hospital, Copenhagen University, Hellerup, Denmark.|The Danish Heart Foundation, Copenhagen, Denmark.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Gislason
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000628:therapy; D000368:Aged; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D009026:Mortality; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012307:Risk Factors; D013453:Sulfonylurea Compounds / Q000627:therapeutic use*
chemical_list: D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds; D008687:Metformin
keywords: metformin; pharmaco-epidemiology; type 2 diabetes