Metformin in Patients With Type 2 Diabetes and Kidney Disease

Metformin is widely recognized as the best initial pharmacological option for lowering glucose levels in type 2 diabetic patients. However, due to concerns about lactic acidosis, many people with impaired renal function ban drugs

In July 2014, we searched articles on human metformin, kidney disease, lactic acidosis between 1950 and June 2014 in the database of MEDLINE and Cochrane. We exclude comments, letters, editorials, case reports, small case series and manuscripts that are not directly related to the subject area or meet other exclusion criteria. Among the original 818 articles 65 were included in this review, including pharmacokinetics / metabolism studies, large scale case series, retrospective studies, meta-analysis and clinical trials.

Although metformin has been eliminated, drug levels are usually maintained within the therapeutic range and when used in patients with mild to moderate chronic kidney disease (estimated glomerular filtration volume, 30 to 60 mL / min per 73 square meters) When lactic acid concentration does not substantially increase. The overall incidence of lactic acidosis in metformin users is different for each study, ranging from about 3 per 100 thousand to 10 per 100 thousand and indistinguishable from the background rate of diabetic patients as a whole There are many. Data showing increased risk of lactic acidosis in patients with chronic kidney disease treated with metformin are limited and no randomized controlled trials have been conducted to test the safety of metformin in patients with renal dysfunction. Population-based research indicates that the metformin prescription may be in violation of current guidelines, suggesting that one out of every 4 people with type 2 diabetes has kidney risk. Observational studies showed that metformin has a potential benefit to large vessel outcome even for patients with ubiquitous renal contraindications.

Evidence available supports the careful extension of metformin use in mild to moderate chronic kidney disease patients as defined by estimated glomerular filtration rate, appropriate dose reduction and prudent follow-up of renal function

Metformin is considered to be the best initial treatment for lowering the blood glucose level of type 2 diabetic patients. Chronic kidney disease (CKD) is a common symptom of type 2 diabetes and may challenge the use of many hypoglycemic agents 2.

A: As an endocrinologist, I take care of people with diabetes. Chronic kidney disease is a common complication of diabetes, and unfortunately patients with chronic kidney disease could not use metformin in the past. I have many patients whose renal function worsens over time and we have to stop Metformin. Metformin seems to be safe from the viewpoint of lactic acidosis of mild to moderate chronic kidney disease, but also seems to be associated with a lower mortality rate and it really seems that we enter the clinical setting I will help. I already have it - I was able to resume metformin for some patients who previously invalidated it

Diabetes - Chronic kidney disease is associated with type 1 and type 2 diabetes. Excessive sugar (glucose) accumulates in the blood if the patient's diabetes is not well managed. In the first 10 years of diabetes, kidney disease is rare; it is more common in 15-25 years after diagnosis of diabetes. Kidney Scan - Kidney Scans include magnetic resonance imaging (MRI) scan, computed tomography (CT) scan, or ultrasound scan. The goal is to judge whether the urine flow is blocked. These scans also show the size and shape of the kidney - the late stage of kidney disease, the kidneys are small and heterogeneous shapes