The Long-term Effects of Metformin on Patients With Type 2 Diabetic Kidney Disease

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Soie Kwon 1 2, Yong Chul Kim 1, Jae Yoon Park 3, Jeonghwan Lee 4, Jung Nam An 5, Clara Tammy Kim 6, Sohee Oh 7, Seokwoo Park 8 9, Dong Ki Kim 1 9, Yun Kyu Oh 2 9, Yon Su Kim 1, Chun Soo Lim 2 9, Jung Pyo Lee 4 9

Main idea: In the present retrospective study, metformin usage in advanced chronic kidney disease (CKD) patients, especially those with CKD 3B, decreased the risk of all-cause mortality and incident ESRD. Additionally, metformin did not increase the risk of lactic acidosis

Abstract

Objective: Metformin is the first pharmacological option for treating type 2 diabetes. However, the use of this drug is not recommended in individuals with impaired kidney function because of the perceived risk of lactic acidosis. We aimed to assess the efficacy and safety of metformin in patients with type 2 diabetic kidney disease (DKD).

Research design and methods: We conducted a retrospective observational cohort study of 10,426 patients with type 2 DKD from two tertiary hospitals. The primary outcomes were all-cause mortality and end-stage renal disease (ESRD) progression. The secondary outcome was metformin-associated lactic acidosis. Taking into account the possibility that patients with less severe disease were prescribed metformin, propensity score matching (PSM) was conducted.

Results: All-cause mortality and incident ESRD were lower in the metformin group according to the multivering Cox analysis. In both the original and PSM groups, met formin usage did not increase the risk of lactic acidosis events from all causes. Only one event of metformine-associated lactic Acidosis was recorded. The study was published in the Journal of Clinical Toxicology.

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