Metformin use in patients with type 2 diabetes mellitus and chronic kidney disease: An evidence-based review.

Abstract

INTRODUCTION:

Practice guidelines advise caution on the use of metformin in patients with type 2 diabetes mellitus with chronic kidney disease (CKD). This review aims to examine the evidence for the benefits and risks of metformin use in patients with T2DM and CKD.

METHODS:

The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials and PubMed were searched; the references of selected papers were hand searched. Systematic reviews, randomised controlled trials, cohort studies, case series and case-control studies were included. The full text of selected articles was reviewed. The outcomes studied were all-cause mortality, cardiovascular complications, lactic acidosis and worsening of renal function. Recommendations were graded according to the Scottish Intercollegiate Guidelines Network system.

RESULTS:

A total of 139 unique articles were identified, 14 of which met the inclusion criteria and were selected for full-text review. Four cohort studies reported an association between metformin use and improved all-cause mortality in CKD stage 4 and better. Two cohort studies reported improved cardiovascular outcomes with metformin use. Four cohort studies, 1 case series and 1 case-control study reported no significant association between metformin use and an increased risk of lactic acidosis in CKD. There is a moderate level of evidence to support reduced mortality, improved cardiovascular outcomes and a low risk of lactic acidosis with metformin use in patients with T2DM and with CKD stage 4 and above.

CONCLUSION:

Existing recommendations to restrict metformin use in diabetes patients with CKD need to be reviewed in light of emerging evidence supporting its overall benefits in these patients.

• Authors: Felicia Clara J H Tan, Seng Bin Ang, Yong Mong Bee
• Journal: Annals of the Academy of Medicine, Singapore (Ann Acad Med Singap) Vol. 50 Issue 2 Pg. 159-170 (02 2021) ISSN: 2972-4066 [Electronic] Singapore
• PMID: 33733259 (Publication Type: Journal Article, Review)

Chemical References

• Hypoglycemic Agents
• Metformin

Topics

• Case-Control Studies
• Diabetes Mellitus, Type 2 (complications, drug therapy, epidemiology)
• Humans
• Hypoglycemic Agents (therapeutic use)
• Metformin (therapeutic use)
• Renal Insufficiency, Chronic (complications, epidemiology)
• Systematic Reviews as Topic