UACR, urinary albumin creatinine ratio LDL-C, low-density lipoprotein cholesterol HDL-C, high-density lipoprotein cholesterol eGFR, estimated glomerular filtration rate ACEI, angiotensin converting enzyme inhibitor ARB, angiotensin II receptor blocker DDP-4, dipeptidyl peptidase-4 Cox, cyclooxygenase. The purpose of this study was to evaluate the effect of continuous metformin treatment on renal function in patients with type 2 DM and moderate CKD (eGFR 30–60 ml/min/1.73 m 2).Ībbreviations. This raises the concern that a decline in renal function in patients with moderate CKD receiving metformin may increase the risk of toxicity to metformin. A previous study reported that the use of metformin in patients with type 2 DM and advanced CKD was associated with a significantly increased risk of all-cause mortality compared with non-users. Therefore, patients with moderate CKD (eGFR 30–59 ml/min/1.73 m 2) are eligible to receive metformin. The revised guidelines stated that the use of metformin is only absolutely contraindicated in patients with severe chronic kidney disease (CKD) (eGFR < 30 ml/min/1.73 m 2). In April 2016, the FDA revised their warning with regards to metformin use in patients with impaired kidney function, defining the renal impairment according to estimated glomerular filtration rate (eGFR). The overall incidence of lactic acidosis in metformin users ranges from approximately 3 per 100,000 person-years to 10 per 100,000 person-years, which is similar to the background rate in patients with type 2 DM. Metformin is primarily excreted unchanged by the kidney, and renal impairment may cause the accumulation of metformin leading to an elevated metformin concentration, and this has been proposed to lead to lactic acidosis. Risk factors including severe dehydration (i.e., reduced tissue perfusion), congestive heart failure, sepsis, shock, hypoxia, hepatic impairment, advanced age, and excessive alcohol intake may also increase the risk of metformin-associated lactic acidosis. The use of metformin is contraindicated in men and women with serum creatinine concentrations of 1.5 mg/dL or higher and 1.4 mg/dL or higher, respectively, due to the risk of the life-threatening complication, lactic acidosis. Food and Drug Administration (FDA) In 1994, and it is generally recommended as the first-line pharmacological agent in management guidelines for patients with type 2 diabetes mellitus (DM) because of its low cost, safety, and association with a reduction in the risk of cardiovascular events. Metformin is an oral hypoglycemic agent of the biguanide class that lowers blood glucose level mainly by decreasing hepatic glucose production and improving insulin sensitivity of the peripheral tissues by increasing peripheral glucose uptake and utilization.
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