Is Metformin Use Safe In Patients With Advanced CKD?

Metformin use in patients with type 2 diabetes and advanced chronic kidney disease (CKD) is associated with greater mortality risk, according toe the results of a recent study.

Previous data have indicated that metformin use, although contraindicated in patients with impaired kidney function, can be used cautiously in those with mild-to-moderate CKD. Evidence is lacking, however, regarding its use in those with advanced CKD.
______________________________________________________________________________________________________________________________________________________________

RELATED CONTENT
Diabetes and Chronic Kidney Disease
Managing Dyslipidemia in Patients with Chronic Kidney Disease
______________________________________________________________________________________________________________________________________________________________

In order to examine the safety of metformin use in these patients, researchers conducted a retrospective, observational cohort study involving 813 metformin users and 2439 non-users.

Over a median follow-up of 2.1 years, all-cause mortality was higher in the 813 metformin users (53%) than in the 2439 non-users (41%), and the increased mortality was dose-dependent.

“Use of metformin in people with type 2 diabetes and a serum creatinine concentration greater than 530 μmol/L is associated with a significantly increased risk of all-cause mortality compared with non-users. Metformin use should not be encouraged in this patient group,” researchers concluded.

—Michael Potts

Reference:
Hung S, Chang Y, Liu J, et al. Metformin use and mortality in patients with advanced chronic kidney disease: national, retrospective, observational, cohort study. Lancet. June 2015 [epub ahead of print]. DOI: http://dx.doi.org/10.1016/S2213-8587(15)00123-0