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Metformin use in renal dysfunction: is a serum creatinine threshold appropriate?
Ann M Philbrick1, Michael E Ernst, Deanna L McDanel
1Department of Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis, USA.
Summary
Metformin is a first-line treatment for type 2 diabetes, but its use is limited by fears of lactic acidosis. Studies show a weak link between metformin and lactic acidosis, suggesting it may be safe for many patients with renal concerns.
Area of Science:
- Endocrinology
- Pharmacology
- Nephrology
Background:
- Metformin is a recommended first-line treatment for type 2 diabetes mellitus (T2DM).
- Concerns regarding metformin-associated lactic acidosis (MALA) and contraindications in renal dysfunction lead to underutilization.
- Existing research has explored the link between metformin, plasma lactate, and lactic acidosis.
Purpose of the Study:
- To discuss the relationship between metformin use, plasma lactate levels, and lactic acidosis in T2DM patients.
- To evaluate the appropriateness of metformin use in patients with renal dysfunction.
Main Methods:
- Review of existing studies and consensus statements.
- Analysis of reported rates of lactic acidosis in metformin users versus non-users.
- Examination of correlations between plasma metformin levels, lactate levels, and mortality.
Main Results:
- The causal relationship between metformin and lactic acidosis is not definitively established.
- Lactic acidosis rates in metformin-treated diabetic patients are similar to those not taking metformin.
- Metformin is often continued in patients with renal dysfunction despite contraindications.
Conclusions:
- Current evidence suggests a weak causal link between metformin and lactic acidosis.
- Elevated serum creatinine should be a risk factor, not an absolute contraindication, for metformin use in patients without other predisposing conditions.
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