Metformin side effects kidney
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Some studies suggest metformin can reduce mortality and improve kidney function in chronic kidney disease patients, while other studies highlight potential risks like lactic acidosis and adverse effects on renal function.
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Metformin Side Effects on Kidney Function
Introduction to Metformin and Kidney Disease
Metformin is a widely used first-line medication for managing type 2 diabetes mellitus (T2DM) due to its efficacy in lowering blood glucose levels and its relatively low cost. However, its use in patients with chronic kidney disease (CKD) has been a subject of ongoing debate due to potential side effects, particularly lactic acidosis .
Risk of Lactic Acidosis in CKD Patients
Lactic acidosis is a serious condition characterized by an increase in arterial lactate levels and a decrease in blood pH. It is a known but rare side effect of metformin, especially in patients with impaired kidney function. Studies have shown that while metformin can increase lactate levels in CKD patients, these levels often remain below the threshold for lactic acidosis . Nonetheless, caution is advised when prescribing metformin to patients with moderate to severe CKD due to the increased risk of lactic acidosis .
Impact on Renal Function
Continuous use of metformin in patients with moderate CKD (eGFR 30-60 ml/min/1.73 m²) has been associated with a decline in renal function. A study involving 616 patients found that those who continued metformin treatment experienced a more significant reduction in eGFR compared to those who discontinued the medication. This suggests that metformin may adversely affect renal function in patients with moderate CKD.
Nephroprotective Effects
Despite the risks, metformin also exhibits nephroprotective properties. It has been shown to reduce renal inflammation, oxidative stress, and fibrosis, which are beneficial in managing diabetic kidney disease (DKD) . Metformin's activation of AMP-activated protein kinase (AMPK) plays a crucial role in these protective effects, helping to mitigate various pathological pathways involved in kidney damage .
Clinical Outcomes and Safety
Clinical studies have demonstrated that metformin use in CKD patients is associated with reduced mortality rates and slower progression to end-stage renal disease (ESRD) . A large retrospective study found that metformin usage was linked to lower all-cause mortality and a reduced incidence of ESRD, with a very low incidence of metformin-associated lactic acidosis (MALA). These findings suggest that, with careful monitoring, metformin can be safely used in patients with CKD, providing significant clinical benefits.
Conclusion
While metformin poses a risk of lactic acidosis and may adversely affect renal function in patients with moderate CKD, it also offers significant nephroprotective benefits. The decision to use metformin in CKD patients should be made cautiously, considering the balance between its potential risks and benefits. Further research, particularly randomized controlled trials, is needed to better understand the safety and efficacy of metformin in this patient population.
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