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2017 ; 18
(1
): 163
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Risk of acute kidney injury and survival in patients treated with Metformin: an
observational cohort study
#MMPMID28526011
Bell S
; Farran B
; McGurnaghan S
; McCrimmon RJ
; Leese GP
; Petrie JR
; McKeigue P
; Sattar N
; Wild S
; McKnight J
; Lindsay R
; Colhoun HM
; Looker H
BMC Nephrol
2017[May]; 18
(1
): 163
PMID28526011
show ga
BACKGROUND: Whether metformin precipitates lactic acidosis in patients with
chronic kidney disease (CKD) remains under debate. We examined whether metformin
use was associated with an increased risk of acute kidney injury (AKI) as a proxy
for lactic acidosis and whether survival among those with AKI varied by metformin
exposure. METHODS: All individuals with type 2 diabetes and available prescribing
data between 2004 and 2013 in Tayside, Scotland were included. The electronic
health record for diabetes which includes issued prescriptions was linked to
laboratory biochemistry, hospital admission, death register and Scottish Renal
Registry data. AKI events were defined using the Kidney Disease Improving Global
Outcomes criteria with a rise in serum creatinine of at least 26.5 ?mol/l or a
rise of greater than 150% from baseline for all hospital admissions. Cox
Regression Analyses were used to examine whether person-time periods in which
current metformin exposure occurred were associated with an increased rate of
first AKI compared to unexposed periods. Cox regression was also used to compare
28 day survival rates following first AKI events in those exposed to metformin
versus those not exposed. RESULTS: Twenty-five thousand one-hundred fourty-eight
patients were included with a total person-time of 126,904 person years. 4944
(19.7%) people had at least one episode of AKI during the study period. There
were 32.4 cases of first AKI/1000pyrs in current metformin exposed person-time
periods compared to 44.9 cases/1000pyrs in unexposed periods. After adjustment
for age, sex, diabetes duration, calendar time, number of diabetes drugs and
baseline renal function, current metformin use was not associated with AKI
incidence, HR 0.94 (95% CI 0.87, 1.02, p = 0.15). Among those with incident AKI,
being on metformin at admission was associated with a higher rate of survival at
28 days (HR 0.81, 95% CI 0.69, 0.94, p = 0.006) even after adjustment for age,
sex, pre-admission eGFR, HbA(1c) and diabetes duration. CONCLUSIONS: Contrary to
common perceptions, we found no evidence that metformin increases incidence of
AKI and was associated with higher 28 day survival following incident AKI.
|Acidosis, Lactic/etiology/*mortality
[MESH]
|Acute Kidney Injury/*etiology/*mortality
[MESH]
|Age Distribution
[MESH]
|Aged
[MESH]
|Cohort Studies
[MESH]
|Comorbidity
[MESH]
|Diabetes Mellitus, Type 2/*drug therapy/*mortality
[MESH]
|Drug-Related Side Effects and Adverse Reactions/*mortality
[MESH]
|Female
[MESH]
|Humans
[MESH]
|Incidence
[MESH]
|Male
[MESH]
|Metformin/adverse effects/*therapeutic use
[MESH]
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