Should Restrictions Be Relaxed for Metformin Use in Chronic Kidney Disease? Yes, They Should Be Relaxed! What’s the Fuss?

Metformin is the first choice of type 2 diabetes for over a quarter of a century. Like other bismuths, metformin is extremely rare but it can cause fatal lactic acidosis. Possibility of lactic acidosis associated with metformin is significantly higher in patients with impaired renal function and in seemingly normal renal function in patients with acute kidney injury (AKI) risk. As a result, regulators in many developed countries have imposed strict kidney restrictions on metformin. However, millions of people have been exposed to metformin for many years, many of which have serum creatinine values ​​close to or close to 5 mg / dL and 60 mL / min / 1.73 m 2 for developing lactic acid far more Below estimate glomerular filtration rate (eGFR) acidosis therefore obviously still controversial in this area, there is already a higher pressure to eliminate metformin kidney restriction. In order to discuss the pros and cons of alleviating the use of kidney restriction in metformin, we provide a point-to-point alignment. In the previous story, Dr.. Kalantar-Zadeh and Kovesdy have little evidence of the potential benefits of metformin for kidney disease but present their views, but consider the absolute number of metformin users and the high mortality associated with lactic acidosis And the most appropriate approach is to avoid. Metformin is used in patients with eGFR 30 mL / min / 1.73 m 2

Chronic kidney disease (CKD) is a common symptom of T2DM and may challenge the use of many hypoglycemic agents.2 There is increasing evidence that the critical point of metformin safety in the United States is too strict. As a result, it may be deprived of metformin, but it may be deprived of metformin 4. In this review, we will search English-related articles related to Medholmin, CKD, lactic acidosis in MEDLINE and Cochrane's database. In the first 818 articles, 65 cases, including pharmacokinetic / metabolic studies, case series, cross-sectional studies, observational studies and drug monitoring studies, meta-analyzes and clinical trials, were eventually reviewed.

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