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Kidney Week

Abstract: FR-PO244

Metformin Use Is Associated with Asymptomatic Hyperlactatemia in Elderly Diabetic Men with Stage 3 CKD

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Gosmanova, Elvira, Stratton VA Medical Center, Albany, New York, United States
  • Shahzad, Sheikh Raza, Albany Medical College, Albany, New York, United States
  • Yalamanchili, Samshita, Albany Medical College, Albany, New York, United States
  • Sumida, Keiichi, University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Gosmanov, Aidar, Stratton VA Medical Center, Albany, New York, United States
Background

Current recommendations allow metformin use in patients with chronic kidney disease stage 3 (CKD3). Whether metformin increases risk of hyperlactatemia in elderly CKD3 diabetic patients is unknown.

Methods

This was a case-control study including 92 stable CKD stage 3 male veterans attending Albany VAMC outpatient clinics in 2018. Patients were grouped according to presence of diabetes (D) and metformin use (M) into 3 groups: CKD3 and no diabetes (CKD3 -24pts), CKD3 and D with no M (CKD3/D -28 pts), and CKD3 and D on metformin (CKD3/D+M -40 pts). Hyperlactatemia was defined as lactic acid (LA)>2mmol/L and lactic acidosis as LA>4mmol/L in association with anion-gap metabolic acidosis. Characteristics associated with hyperlactatemia were evaluated in multivariable logistic regression analyses adjusted for age, race, BMI, eGFR, proteinuria, A1C, liver enzymes, Charlson comorbidity index, number of prescription drugs, and metformin and insulin use.

Results

In the total cohort, mean(SD) for age was 73.4(5.9) yrs and mean(SD) eGFR was 46.7(8.1)ml/min/1.73m2. For CKD3, CKD3/D and CKD3/D+M groups mean(SD) LA levels were 1.3(0.3), 1.3(0.4) and 2.1(1.0)mmol/L (p<0.001) and eGFR were 43.2(7.8), 44.3 (8.7) and 50.6(6.1) ml/min/1.73m2(p<0.001), respectively. Hyperlactatemia was present in 1(4.2%), 1(3.6%) and 17(42.5%) of CKD3, CKD3/D and CKD3/D+M patients, correspondingly. A single case of asymptomatic lactic acidosis was seen among CKD3/D+M group. Daily metformin dose correlated with LA levels (r=0.35, p=0.027). In multivariable adjusted regression analysis metformin use was significantly associated with hyperlactatemia (Figure 1).

Conclusion

Metformin use in elderly diabetic patients with CKD stage 3 was associated with high incidence of asymptomatic hyperlactatemia. Routine monitoring of LA levels may be warranted in diabetic CKD 3 patients treated with metformin.

Figure 1