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Metformin-associated acute kidney injury and lactic acidosis.

Arroyo D, Melero R, Panizo N, Goicoechea M, Rodríguez-Benítez P, Vinuesa SG, Verde E, Tejedor A, Luño J - Int J Nephrol (2011)

Bottom Line: Conclusions.AKI associated to an episode of volume depletion due to gastrointestinal losses is a serious complication in type 2 diabetic patients on metformin.Previous renal dysfunction (mild-to-moderate CKD) has no influence on the severity or outcome.

View Article: PubMed Central - PubMed

Affiliation: Nephrology Department, Hospital General Universitario Gregorio Marañón, Street Dr. Esquerdo 46, 28007 Madrid, Spain.

ABSTRACT
Objectives. Metformin is the preferred oral antidiabetic agent for type 2 diabetes. Lactic acidosis is described as a rare complication, usually during an acute kidney injury (AKI). Material and Methods. We conducted a prospective observational study of metformin-associated AKI cases during four years. 29 cases were identified. Previous renal function, clinical data, and outcomes were recorded. Results. An episode of acute gastroenteritis precipitated the event in 26 cases. Three developed a septic shock. Three patients died, the only related factor being liver dysfunction. More severe metabolic acidosis hyperkalemia and anemia were associated with higher probabilities of RRT requirement. We could not find any relationship between previous renal dysfunction and the outcome of the AKI. Conclusions. AKI associated to an episode of volume depletion due to gastrointestinal losses is a serious complication in type 2 diabetic patients on metformin. Previous renal dysfunction (mild-to-moderate CKD) has no influence on the severity or outcome.

No MeSH data available.


Related in: MedlinePlus

Influence of previous renal function on renal replacement therapy requirement during the acute kidney injury episode. Number and percentage of patients that required renal replacement therapies in relation with previous renal function. ∗Previous renal function expressed as estimated glomerular filtration rate in mL/min/1.73 m2 calculated according to the MDRD-4-IMDS formula.
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fig1: Influence of previous renal function on renal replacement therapy requirement during the acute kidney injury episode. Number and percentage of patients that required renal replacement therapies in relation with previous renal function. ∗Previous renal function expressed as estimated glomerular filtration rate in mL/min/1.73 m2 calculated according to the MDRD-4-IMDS formula.

Mentions: Patients with lower plasma pH, higher level of potassium, lower serum proteins, and lower hemoglobin concentration had a higher probability of requiring RRT (Table 2). We detected no cases of lactic acidosis related to long-term metformin use without a concomitant AKI. Previous renal dysfunction had no influence on the outcome: a worse chronic kidney disease stage did not imply a higher risk of needing dialysis. In fact, 91.7% of the patients with a previous eGFR over 60 mL/min/1.73 m2 needed RRT, yet only 47.1% of the patients with CKD did (P = 0.013). This significant difference could also be seen in the subgroups analysis (Figure 1).


Metformin-associated acute kidney injury and lactic acidosis.

Arroyo D, Melero R, Panizo N, Goicoechea M, Rodríguez-Benítez P, Vinuesa SG, Verde E, Tejedor A, Luño J - Int J Nephrol (2011)

Influence of previous renal function on renal replacement therapy requirement during the acute kidney injury episode. Number and percentage of patients that required renal replacement therapies in relation with previous renal function. ∗Previous renal function expressed as estimated glomerular filtration rate in mL/min/1.73 m2 calculated according to the MDRD-4-IMDS formula.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3139902&req=5

fig1: Influence of previous renal function on renal replacement therapy requirement during the acute kidney injury episode. Number and percentage of patients that required renal replacement therapies in relation with previous renal function. ∗Previous renal function expressed as estimated glomerular filtration rate in mL/min/1.73 m2 calculated according to the MDRD-4-IMDS formula.
Mentions: Patients with lower plasma pH, higher level of potassium, lower serum proteins, and lower hemoglobin concentration had a higher probability of requiring RRT (Table 2). We detected no cases of lactic acidosis related to long-term metformin use without a concomitant AKI. Previous renal dysfunction had no influence on the outcome: a worse chronic kidney disease stage did not imply a higher risk of needing dialysis. In fact, 91.7% of the patients with a previous eGFR over 60 mL/min/1.73 m2 needed RRT, yet only 47.1% of the patients with CKD did (P = 0.013). This significant difference could also be seen in the subgroups analysis (Figure 1).

Bottom Line: Conclusions.AKI associated to an episode of volume depletion due to gastrointestinal losses is a serious complication in type 2 diabetic patients on metformin.Previous renal dysfunction (mild-to-moderate CKD) has no influence on the severity or outcome.

View Article: PubMed Central - PubMed

Affiliation: Nephrology Department, Hospital General Universitario Gregorio Marañón, Street Dr. Esquerdo 46, 28007 Madrid, Spain.

ABSTRACT
Objectives. Metformin is the preferred oral antidiabetic agent for type 2 diabetes. Lactic acidosis is described as a rare complication, usually during an acute kidney injury (AKI). Material and Methods. We conducted a prospective observational study of metformin-associated AKI cases during four years. 29 cases were identified. Previous renal function, clinical data, and outcomes were recorded. Results. An episode of acute gastroenteritis precipitated the event in 26 cases. Three developed a septic shock. Three patients died, the only related factor being liver dysfunction. More severe metabolic acidosis hyperkalemia and anemia were associated with higher probabilities of RRT requirement. We could not find any relationship between previous renal dysfunction and the outcome of the AKI. Conclusions. AKI associated to an episode of volume depletion due to gastrointestinal losses is a serious complication in type 2 diabetic patients on metformin. Previous renal dysfunction (mild-to-moderate CKD) has no influence on the severity or outcome.

No MeSH data available.


Related in: MedlinePlus