Abstract
There are few publications reporting adverse effects of metformin for patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Although some of these reports have made big claims about the adverse effects of metformin in patients with renal failure, the majority of studies showed a superior safety profile for metformin compared with other antidiabetic medications in these patients. Further, metformin use is not contributing to an increased incidence of acute kidney injury (AKI). In conclusion, we suggest that a low dose of metformin is safe to use in patients with or without CKD. Multicenter randomized trials are required to further discover the benefits of the risk of metformin therapy in different stages of CKD and its effect on progression of CKD.
Highlights
Metformin is a biguanide used in the treatment of type 2 diabetes mellitus (T2DM)
We searched for metformin, end-stage renal disease (ESRD), T2DM, glomerular filtration rate, acute kidney injury (AKI), chronic kidney disease (CKD), lactic acidosis symptom, side effect, adverse effect and mortality
Several lines of evidence demonstrated that hyperglycemia suppresses the 5’ AMP-activated protein kinase (AMPK) and amplifies activation of mammalian target of rapamycin pathway, that lead to simulation of kidney hypertrophy and renal injury contributing to diabetic nephropathy [13, 14]
Summary
Metformin has relevant pleiotropic effects on different organs specially the kidney. Numerous studies demonstrated that metformin mitigates the pathophysiological changes (such as fibrosis, inflammation and apoptosis) associated with chronic kidney disease (CKD). Using metformin in patients with moderate to advanced renal damage has been a debatable subject since, with recommendations that seem contradictory in different guidelines [1]. Consensus Report by the American Diabetes Association and European Association for the Study of Diabetes, discouraged the use of metformin in patients with an estimated glomerular filtration rate (eGFR) of 30–45 mL/min/1.73 m2. The New Zealand Medsafe guidelines suggest metformin withdrawal when eGFR is less than 15 mL/min/1.73 m2 [2]. The Food and Drug Administration (FDA) guidelines suggest that metformin should not be used in patients with an eGFR of
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