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Metformin seen as safe in patients with diabetic CKD

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SAN DIEGO — Patients with diabetic chronic kidney disease who used metformin showed all-cause mortality and ESRD progression benefits, according to data presented at ASN Kidney Week 2018.

“Diabetes is the leading cause of chronic kidney diseases in the United States ... Even though metformin is the first-line treatment of choice for type 2 diabetes, it was prohibited for CKD patients because of the perceived risk of lactic acidosis,” Soie Kwon, a third-year resident at Seoul National University Hospital in Seoul, the Republic of Korea, said during her presentation.

However, the perception of metformin is changing, she said.

Kwon and colleagues conducted a retrospective, observational cohort study to determine the efficacy and safety of metformin in patients with type 2 diabetic CKD (n = 10,426). The researchers evaluated all-cause-mortality and ESRD progression by comparing patients using metformin (n =3,183) with those not using the drug (n = 7,243).

At the time of enrollment, metformin users were more likely to be female and young and have a higher eGFR, BMI and HbA1c.

Results showed patients who used metformin had significantly better all-cause mortality rates than those who did not use metformin (adjusted HR = 0.54; 95% CI, 0.48-0.62). Additionally, metformin users demonstrated longer duration of ESRD progression (aHR = 0.47;95% CI, 0.41-0.53).

In a propensity score-matching analysis based on similar age, gender, hypertension, liver disease, BMI, Hba1c and eGFR, metformin users consistently showed superiority in all-cause mortality (aHR = 0.52, 95% CI, 0.46–0.6) and ESRD progression (aHR = 0.5; 95% CI, 0.43–0.58).

One case of a metformin-associated lactic acidosis event was observed in the metformin user group.

Kwon said, “Metformin can be safely considered in CKD patients because of its advantage in all-cause mortality and ESRD progression, but we have some limitations in the study and more research is needed regarding cumulative dose effect, dose adjustment and monitoring method.” – by Alaina Tedesco

Reference:

Kwon S, et al. Abstract: TH-OR032. Presented at: ASN Kidney Week 2018; Oct. 23-28, 2018; San Diego.

Disclosure: Healio Nephrology was unable to confirm relevant financial disclosures at the time of publication.