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Abstract: TH-OR032

Metformin Treatment in Patients with Type 2 Diabetes and CKD

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Kwon, Soie, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Kim, Yong Chul, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Park, Jae Yoon, Dongguk University Ilsan Hospital, Gyeonggido, Korea (the Republic of)
  • An, Jung Nam, Seoul National University Boramae Medical Center, Seoul, Korea (the Republic of)
  • Kim, Dong Ki, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Lee, Jung Pyo, Seoul National University Boramae Medical Center, Seoul, Korea (the Republic of)
Background

Metformin is widely used as the first pharmacological option in the patients with type 2 diabetes mellitus. However, use of this drug has not been recommend in individuals with impaired kidney function because of the perceived risk of lactic acidosis. We aimed to assess the efficacy and safety of metformin in patients with type 2 diabetic chronic kidney disease (CKD).

Methods

We conducted a retrospective, observational, cohort study of 10,426 patients with type 2 diabetic CKD who followed the nephrology clinic at two tertiary hospitals from 2001 to 2016. We compared 3,183 patients who used metformin with 7,243 who did not use metformin. Primary outcomes were all-cause-mortality and end-stage renal disease (ESRD) progression. Secondary outcomes were event of metformin associated lactic acidosis and maximal lactate level in all events of lactic acidosis. Cox multivariate analysis and propensity score matching were conducted.

Results

The patients who used metformin had more female proportion, younger, higher eGFR, higher BMI and higher HbA1c level at the time of enrollment. All-cause-mortality for metformin-user group was significantly better than that that of non-metformin user in the multivariable cox analysis (P value <0.001 adjusted hazard ratio [aHR] 0.54, 95% confidence interval [C.I.] 0.48 - 0.62). Also, MFM group has longer duration of ESRD progression. (P value < 0.001, aHR 0.47, 95% CI 0.41 – 0.53). Because two group had significantly different baseline characteristics, we did a propensity score matching by age, gender, hypertension, liver disease, BMI, Hba1c and eGFR. Metformin usage consistently has superiority in all-cause-mortality (P value <0.001, aHR 0.52, 95% CI 0.46 – 0.60) and ESRD progression (P value <0.001, aHR 0.50, 95% CI 0.43 – 0.58) in matched group. There was only one case of metformin associated lactic acidosis event in metformin user group. But there was no difference in maximal lactate level. (P value 0.966)

Conclusion

In Korean diabetic CKD patients, metformin can be safely considered. However, more researches about cumulative dose effect, dose adjustment and monitoring method are needed.

Edit Table - Uni-variate cox analysis about primary outcome in matched group
 Hazard ratio95% CIP value
All-cause-mortality0.520.46 - 0.60<0.001
ESRD progression0.500.43 - 0.58<0.001