Diabetes News/Recent Literature Review/ First Quarter 2018
Metformin Treatment in Patients with Type 2 Diabetes and Chronic Kidney Disease Stages 3A, 3B, or 4
The safety of metformin was examined in moderate and severe chronic kidney disease (CKD)( stages 3A/3B and 4, eGFR 59-45, 44-30, and <15 mL/min/1.72 m2 , respectively). Three metformin doses were examined: 1,500mg (0.5 g in the morning [qam]+ 1g in the evening [qpm]) in CKD3A, 1,000 mg (0.5g qam + o.5 g qpm ) in CKD3B, and 500 mg (qam) in CKD 4. After 4 months on these regimens, patients displayed stable metformin concentrations that never exceeded the safe upper limit of 5.0 mg/L. Hyperlactatemia was absent, and HbA1c levels did not change. The study provided solid basis for the continuing metformin treatment in patients with moderate or severe CKD, supporting the recent guidelines on metformin treatment, providing that the dose is adjusted to the eGFR (Lalau JD et al, Diabetes Care 2018;43:547-553).
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