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2017 ; 18
(1
): 229
Nephropedia Template TP
gab.com Text
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Twit Text #
English Wikipedia
Serum lactate level and mortality in metformin-associated lactic acidosis
requiring renal replacement therapy: a systematic review of case reports and case
series
#MMPMID28693440
Yeh HC
; Ting IW
; Tsai CW
; Wu JY
; Kuo CC
BMC Nephrol
2017[Jul]; 18
(1
): 229
PMID28693440
show ga
BACKGROUND: The current practice concerning timing, mode, and dose of renal
replacement therapy (RRT) in patients with metformin-associated lactic acidosis
(MALA) with renal failure remains unknown. To investigate whether serum lactate
level and prescription pattern of RRT are associated with mortality in patients
with MALA requiring RRT. METHODS: We searched PubMed/Medline and EMBASE from
inception to Sep 2014 and applied predetermined exclusion criteria. Case-level
data including case's demographics and clinical information related to MALA were
abstracted. Multiple logistic regression modeling was used to examine the
predictors of mortality. RESULTS: A total of 253 unique cases were identified
with cumulative mortality of 17.2%. Eighty-seven percent of patients had acute
kidney injury. Serum lactate level was significantly higher in non-survivors
(median 22.5 mmol/L) than in survivors (17.0 mmol/L, p-value <0.01) and so did
the median blood metformin concentrations (58.5 vs. 43.9 mg/L, p-value = 0.05).
The survival advantage was not significantly different between the modalities of
RRT. The adjusted odds ratio of mortality for every one mmol/L increase in serum
lactate level was 1.09 (95% CI 1.02-1.17, p-value = 0.01). The dose-response
curve indicated a lactate threshold greater than 20 mmol/L was significantly
associated with mortality. CONCLUSIONS: Our study suggests that predialysis level
of serum lactate level is an important marker of mortality in MALA patients
requiring RRT with a linear dose-response relationship. To better evaluate the
optimal prescription of RRT in MALA, we recommend fostering an international
consortium to support prospective research and large-scale standardized case
collection.