Does Metformin Use Increase the Risk of Acidosis in CKD?

Not linked to incident acidosis overall, in those with eGFR levels of 30 to 44, 45 to 59 mL/min/1.73 m².
Not linked to incident acidosis overall, in those with eGFR levels of 30 to 44, 45 to 59 mL/min/1.73 m².

HealthDay News — Metformin use is associated with an increased risk of acidosis at estimated glomerular filtration rate (eGFR) <30mL/min/1.73 m², according to a study published in the July issue of JAMA Internal Medicine.

Benjamin Lazarus, MBBS, MPH, from the Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues quantified the correlation between metformin use and hospitalization with acidosis among 75,413 patients with diabetes. The results were replicated in 67,578 new metformin users and 14,439 new sulfonylurea users from 2010 to 2015. 

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The researchers found that over a median follow-up of 5.7 years, there were 2335 hospitalizations with acidosis. Time-dependent metformin use was not associated with incident acidosis overall (adjusted hazard ratio [aHR], 0.98; 95% confidence interval [CI], 0.89 to 1.08) or in those with eGFR 45 to 59 and 30 to 44 mL/min/1.73 m² (aHR, 1.16 [95% CI, 0.95 to 1.41] and 1.09 [95% CI, 0.83 to 1.44]) compared with alternative diabetes management. At eGFR below 30 mL/min/1.73 m², metformin use was correlated with increased risk of acidosis (aHR, 2.07; 95% CI, 1.33 to 3.22). The results were consistent when new metformin users were compared with new sulfonylurea users, in a propensity-matched cohort, with exclusion of baseline insulin users, and in the replication cohort.

"Our results support cautious use of metformin in patients with type 2 diabetes and eGFR of at least 30 mL/min/1.73 m²," the authors write.

One author disclosed ties to the pharmaceutical industry.

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