Could metformin be used in patients with diabetes and advanced chronic kidney disease?
Diabetes is an important cause of end stage renal failure worldwide. As renal impairment progresses, managing hyperglycaemia can prove increasingly challenging, as many medications are contra-indicated in moderate to severe renal impairment. Whilst evidence for tight glycaemic control reducing progression to renal failure in patients with established renal disease is limited, poor glycaemic control is not desirable, and is likely to lead to progressive complications. Metformin is a first-line therapy in patients with Type 2 diabetes, as it appears to be effective in reducing diabetes related end points and mortality in overweight patients. Cessation of metformin in patients with progressive renal disease may not only lead to deterioration in glucose control, but also to loss of protection from cardiovascular disease in a cohort of patients at particularly high risk. We advocate the need for further study to determine the role of metformin in patients with severe renal disease (chronic kidney disease stage 4-5), as well as patients on dialysis, or pre-/peri-renal transplantation. We explore possible roles of metformin in these circumstances, and suggest potential key areas for further study.
Department of Diabetes, Barts and the London School of Medicine and Dentistry, The Royal London Hospital, London, UK.
Tahseen A
TA
Chowdhury
Department of Diabetes, Barts and the London School of Medicine and Dentistry, The Royal London Hospital, London, UK.
Danushan
D
Srirathan
Department of Nephrology, Pondicherry Institute of Medical Sciences, Madras Medical Mission, Chennai, India.
Georgi
G
Abraham
Department of Nephrology, Singapore General Hospital, Singapore, Singapore.
Elizabeth L
EL
Oei
Department of Nephrology, Barts and the London School of Medicine and Dentistry, The Royal London Hospital, London, UK.
Stanley L
SL
Fan
Department of Nephrology, Barts and the London School of Medicine and Dentistry, The Royal London Hospital, London, UK.
Kieran
K
McCafferty
Department of Nephrology, Barts and the London School of Medicine and Dentistry, The Royal London Hospital, London, UK.
M Magdi
MM
Yaqoob
D000140:Acidosis, Lactic / Q000139:chemically induced; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000453:epidemiology*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D008687:Metformin / Q000627:therapeutic use*; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D012720:Severity of Illness Index
D007004:Hypoglycemic Agents; D008687:Metformin
chronic kidney disease; diabetes; lactic acidosis; metformin