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2014 ; 34
(4
): 368-75
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Metformin in peritoneal dialysis: a pilot experience
#MMPMID24584596
Al-Hwiesh AK
; Abdul-Rahman IS
; El-Deen MA
; Larbi E
; Divino-Filho JC
; Al-Mohanna FA
; Gupta KL
Perit Dial Int
2014[Jun]; 34
(4
): 368-75
PMID24584596
show ga
OBJECTIVE: In a number of patients, the antidiabetic drug metformin has been
associated with lactic acidosis. Despite the fact that diabetes mellitus is the
most common cause of end-stage renal disease (ESRD) and that peritoneal dialysis
(PD) is an expanding modality of treatment, little is known about optimal
treatment strategies in the large group of PD patients with diabetes. In patients
with ESRD, the use of metformin has been limited because of the perceived risk of
lactic acidosis or severe hypoglycemia. However, metformin use is likely to be
beneficial, and PD might itself be a safeguard against the alleged complications.
METHODS: Our study involved 35 patients with insulin-dependent type 2 diabetes
[median age: 54 years; interquartile range (IQR): 47-59 years] on automated PD
(APD) therapy. Patients with additional risk factors for lactic acidosis were
excluded. Metformin was introduced at a daily dose in the range 0.5 - 1.0 g. All
patients were monitored for glycemic control by blood sugar levels and HbA1c.
Plasma lactic acid levels were measured weekly for 4 weeks and then monthly to
the end of the study. Plasma and effluent metformin and plasma lactate levels
were measured simultaneously. RESULTS: In this cohort, the median duration of
diabetes was 18 years (IQR: 14 - 21 years), median time on PD was 31 months (IQR:
27 - 36 months), and median HbA1c was 6.8% (IQR: 5.9% - 6.9%). At metformin
introduction and at the end of the study, the median anion gap was 11 mmol/L
(IQR: 9 - 16 mmol/L) and 12 mmol/L (IQR: 9 - 16 mmol/L; p > 0.05) respectively,
median pH was 7.33 (IQR: 7.32 - 7.36) and 7.34 (IQR: 7.32 - 7.36, p > 0.05)
respectively, and mean metformin concentration in plasma and peritoneal fluid was
2.57 ± 1.49 mg/L and 2.83 ± 1.7 mg/L respectively. In the group overall, mean
lactate was 1.39 ± 0.61 mmol/L, and hyperlactemia (>2 mmol/L to 5 mmol/L) was
found in 4 of 525 plasma samples (0.76%), but the patients presented no symptoms.
None of the patients registered a plasma lactate level above 5 mmol/L. We
observed no correlation between plasma metformin and plasma lactate (r = 0.27).
CONCLUSIONS: Metformin may be used with caution in APD patients with
insulin-dependent type 2 diabetes. Although our study demonstrated the
feasibility of metformin use in APD, it was not large enough to demonstrate
safety; a large-scale study is needed.
|Acidosis, Lactic/chemically induced/prevention & control
[MESH]
|Adult
[MESH]
|Aged
[MESH]
|Blood Glucose/metabolism
[MESH]
|Diabetes Mellitus, Type 2/complications/*drug therapy
[MESH]
|Female
[MESH]
|Glycated Hemoglobin/metabolism
[MESH]
|Humans
[MESH]
|Hypoglycemic Agents/adverse effects/*therapeutic use
[MESH]
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