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Relationship Between Plasmatic Metformin Concentration and Renal Replacement Therapy: A Multicenter Cohort Study
Lise Demaretz1,2, Guillaume Claisse3, Cornélie Fanton-D'Andon1
1Laboratory of Pharmacology, Toxicology and Blood Gases, University Hospital of Saint Etienne.
Therapeutic Drug Monitoring
|August 1, 2022
Summary
This study identified metformin plasma concentration thresholds associated with lactic acidosis (17.9 mg/L) and dialysis (17.5 mg/L) in type 2 diabetes patients. These findings may guide future clinical management of metformin toxicity.
Area of Science:
- Pharmacology
- Nephrology
- Endocrinology
Background:
- Metformin is a primary treatment for type 2 diabetes mellitus.
- Metformin-associated lactic acidosis (MALA) is a severe adverse effect, but its exact cause remains debated.
- Defining metformin toxicity and dialysis thresholds is crucial for patient safety.
Purpose of the Study:
- To determine the metformin toxicity threshold predicting lactic acidosis.
- To establish the metformin dialysis threshold correlated with dialysis initiation.
Main Methods:
- Retrospective multicenter cohort study (January 2013 - December 2020).
- Included adult patients with detectable metformin blood concentrations.
- Receiver operating characteristic (ROC) analysis to identify thresholds.
Main Results:
- A metformin plasma concentration of 17.9 mg/L was associated with lactic acidosis (90.5% specificity).
- A metformin plasma concentration of 17.5 mg/L was associated with dialysis (94.2% specificity).
Conclusions:
- Identified preliminary metformin plasma concentration thresholds for lactic acidosis and dialysis.
- These thresholds may serve as a basis for future prospective studies.
- Further research is needed to validate these values as therapeutic guides.
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