Metformin in peritoneal dialysis: a pilot experience

Area of Science:

• Nephrology
• Endocrinology
• Pharmacology

Background:

• Diabetes mellitus is a leading cause of end-stage renal disease (ESRD).
• Peritoneal dialysis (PD) is an expanding treatment modality for ESRD.
• Metformin use in ESRD patients is limited due to concerns about lactic acidosis and hypoglycemia.

Purpose of the Study:

• To evaluate the feasibility and safety of metformin use in patients with type 2 diabetes undergoing automated peritoneal dialysis (APD).
• To assess the risk of lactic acidosis in APD patients treated with metformin.

Main Methods:

• A cohort of 35 patients with insulin-dependent type 2 diabetes on APD therapy was studied.
• Patients with additional risk factors for lactic acidosis were excluded.
• Metformin was initiated at 0.5-1.0 g daily, with monitoring of glycemic control, plasma lactic acid, and metformin levels.

Main Results:

• No significant changes in anion gap or pH were observed during metformin treatment.
• Mean plasma lactate levels remained within normal limits, with minimal hyperlactemia (0.76% of samples).
• No correlation was found between plasma metformin and plasma lactate levels.

Conclusions:

• Metformin can be cautiously used in APD patients with type 2 diabetes.
• The study demonstrated the feasibility of metformin use in this population.
• Larger studies are required to definitively establish the safety profile of metformin in APD patients.