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Could metformin be used in patients with diabetes and advanced chronic kidney disease?
Author(s) -
Chowdhury Tahseen A.,
Srirathan Danushan,
Abraham Georgi,
Oei Elizabeth L.,
Fan Stanley L.,
McCafferty Kieran,
Yaqoob M. Magdi
Publication year - 2017
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.12799
Subject(s) - medicine , metformin , diabetes mellitus , kidney disease , disease , dialysis , type 2 diabetes , intensive care medicine , renal replacement therapy , endocrinology
Diabetes is an important cause of end stage renal failure worldwide. As renal impairment progresses, managing hyperglycaemia can prove increasingly challenging, as many medications are contra‐indicated in moderate to severe renal impairment. Whilst evidence for tight glycaemic control reducing progression to renal failure in patients with established renal disease is limited, poor glycaemic control is not desirable, and is likely to lead to progressive complications. Metformin is a first‐line therapy in patients with Type 2 diabetes, as it appears to be effective in reducing diabetes related end points and mortality in overweight patients. Cessation of metformin in patients with progressive renal disease may not only lead to deterioration in glucose control, but also to loss of protection from cardiovascular disease in a cohort of patients at particularly high risk. We advocate the need for further study to determine the role of metformin in patients with severe renal disease (chronic kidney disease stage 4‐5), as well as patients on dialysis, or pre‐/peri‐renal transplantation. We explore possible roles of metformin in these circumstances, and suggest potential key areas for further study.