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Metformin and kidney disease
Letters To The Editor, cleveland Clinic Journal of Medicine. 2014 October;81(10 586-593, author(s Talha. Imam, MD, kaiser Permanente, Fontana, CA, pdfpdf. References, to the Editor: In their article about the care of patients with advanced chronic kidney disease, Sakhuja et al 1 mentioned that metformin is contraindicated in chronic kidney disease. Metformin metformin and kidney disease is a good and useful drug. Not only metformin and kidney disease is it one of the cheapest antidiabetic medications, it is the only one shown to reduce cardiovascular mortality rates in type 2 diabetes mellitus. Although metformin is thought to increase the risk of lactic acidosis, a Cochrane review2 found that the incidence of lactic acidosis was only.3 cases per 100,000 patient-years in patients taking metformin, compared with.4 cases per 100,000 patient-years in patients not taking metformin. Furthermore, in a large registry of patients with type 2 diabetes and atherothrombosis,3 the rate of all-cause mortality was 24 lower in metformin users than in nonusers, and in those who had moderate renal impairment (creatinine clearance 3059 mL/min/1.73 m2) the difference was.3. A trial by Rachmani et al4 raised questions about the standard contraindications to metformin. The authors reviewed 393 patients who had at least one contraindication to metformin but who were receiving it anyway. Their serum creatinine levels ranged from.5.5 mg/dL. There were no cases of lactic acidosis reported. The patients were then randomized either to continue taking metformin or to stop taking. At 2 years, the group that had stopped taking it had gained more weight, and their glycemic control was worse. In the Cochrane analysis,2 although individual creatinine levels were not available, 53 of the studies reviewed did not exclude patients with serum creatinine levels higher than.5 mg/dL. This equated to 37,360 patient-years of metformin use in studies that included patients with chronic kidney disease, and did not lead to lactic acidosis. Even though metformins US package insert says that it is contraindicated if the serum creatinine level.5 mg/dL or higher in men.4 mg/dL or higher in women or if the creatinine clearance is abnormal, in view of the available evidence, many countries. The current contraindication to metformin in chronic kidney disease needs to be reviewed. In poor countries like India, this cheap medicine may be the only option available for metformin and kidney disease treating type 2 diabetes mellitus, and it remains the first-line therapy for type 2 diabetes mellitus metformin and kidney disease as recommended metformin and kidney disease by the International Diabetes Federation, the American Diabetes Association, and the European. Next Article: In reply: Why is metformin contraindicated in chronic kidney disease? Related Articles, letters To The Editor. Latest Diabetes News, tuesday, Dec. 23, 2014 (HealthDay News) - Although metformin, the popular type 2 diabetes medication, is usually not prescribed for people with kidney disease, a new analysis shows the drug may be safer for these patients than once thought. Metformin has been used in the United States for two decades to help lower blood sugar levels among people with type 2 diabetes. Food and Drug Administration cautions that people with kidney disease should not take the drug because it could increase their risk for a potentially serious condition called lactic acidosis.
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