In January, the electronic Medicines Compendium (e MC) updated the Summary of Product Characteristics for Glucophage (metformin), approved by the UK Medicines and Healthcare Products Regulatory Agency (MHRA). Nicholas I Cole, Pauline A Swift, Rebecca J Suckling, Peter A Andrews South West Thames Renal Department, Epsom and St Helier University Hospitals, Surrey, UK Address for correspondence: Dr Nicholas Cole Renal Department, St Helier Hospital, Wrythe Lane, Carshalton, Surrey SM5 1AA, UK Tel: 44 (0)7758217166 Fax: 44 (0)2082962857 E-mail: [email protected] Type 2 diabetes mellitus and chronic kidney disease (CKD) frequently co-exist and the increasing burden of both conditions is a global concern. Metformin is established as the first-line treatment for type 2 diabetes because it is associated with improved cardiovascular outcomes and a reduced risk of hypoglycaemia compared with other treatment options. Patients with CKD may benefit in particular because they are at high risk of both cardiovascular disease and hypoglycaemic episodes. However, the use of metformin is restricted in this population due to the concerns over lactic acidosis. Recent reviews have evaluated this risk and concluded that current guidelines for prescribing metformin in CKD may be too restrictive. This narrative review considers this evidence further, but also examines the strength of evidence that favours the use of metformin in CKD patients. 2016;8-175 Key words: type 2 diabetes mellitus, chronic kidney disease, metformin, biguanides, lactic acidosis, lactate, cardiovascular disease, hypoglycaemia Chronic kidney disease (CKD) commonly co-exists with diabetes mellitus; the estimated prevalence of Kidney Disease Outcomes Quality Initiative (KDOQI) stage 3–5 CKD in the UK for those with diabetes is 31%.
Apr 8, 2016. expand metformin's use in certain patients with reduced kidney. diabetes--a population-based study of adherence to prescribing guidelines. Goergen SK, Rumbold G, Compton G, Harris C. Systematic review of current guidelines, and their evidence base, on risk of lactic acidosis after administration of contrast medium for patients receiving metformin. Radiology 2010; 21.