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Abstract: PO0207

Seventy-Two Cases of Metformin-Associated Lactic Acidosis( MALA): Clinical Presentation and Evolution Analysis

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Pena Porta, Jose M., Hospital Clinico Universitario Lozano Blesa, Zaragoza, Aragón, Spain
  • Gascó, José Ferreras, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Aragón, Spain
  • Castellano, Almudena, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Aragón, Spain
  • Juárez Mayor, Paula, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Aragón, Spain
  • Coscojuela Otto, Ana, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Aragón, Spain
  • Inigo Gil, Pablo J., Hospital Clinico Universitario Lozano Blesa, Zaragoza, Aragón, Spain
  • Alvarez lipe, Rafael, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Aragón, Spain
Background

MALA is a complication that continues to occur today. It is important to collect large series of cases to better understand the clinical presentation and evolution of this condition.

Methods

We collected the MALA cases (diagnostic criteria: pH ≤ 7.5; lactate ≥ 5 mmol / L) in a 700-bed tertiary hospital during the period January 2010-December 2020. We analyzed the clinical factors and laboratory tests associated with the presentation of the condition, as well as mortality.

Results

72 cases were registered (38 men; 52.8%). Average age 76.03 ± 10.37 years. Metformin serum levels were available in 46 patients (mean: 26.41 ± 17.87 mcg / ml; toxic if> 5 mcg / ml). Mean length of stay 11.61 ± 9.7 days. Average Charlson comorbidity index 5.7 ± 1.8 points. Ingested milligrams / day of metformin: 1788.89 ± 395.8. 29 patients had a history of chronic kidney disease (CKD) (40.3% of the total). Cases in the context of acute kidney injury (AKI): 70 (97.2% of the total; 7 KDIGO stage 1 cases, 6 stage 2, 57 stage 3). 90.2% were AKI of prerenal origin. 26 patients required admission to the ICU (36.1%). 10 cases received hemodiafiltration, 26 cases hemodialysis. Mean analytical parameters: pH 7.10 ± 0.19; Lactate 10.12 ± 5.3 mmol / l; bicarbonate 10.94 ± 5.3 mmol / l; GAP anion 27.23 ± 7.6 mmol / l; pCO2 31.9 ± 12.22 mmHg; potassium 6.25 ± 1.42 meq / l; hemoglobin 11.51 ± 2.3 g / dl. Overdose occurred in 17 cases (23.6%).
The statistical analysis detected the existence of a linear association between: metformin and peak creatinine levels (Spearman's r 0.48, p = 0.001); metformin levels and pH (Spearman's r -0.37, p = 0.000); metformin and lactate levels (Pearson's r 0.42, p = 0.004); potassium and pH levels (Spearman's Rho 0.35, p = 0.003); Charlson index and number of active drugs (Pearson's r 0.38, p = 0.001). 17 patients died (mortality 23.6%). A multivariate logistic regression model detected pH (OR 0.003; 95% CI 0.00-0.380) and peak creatinine (OR 0.706; 95% CI 0.49-1.008) as the variables independently associated with mortality.

Conclusion

Virtually all cases occurred in the context of severe AKI, the majority of prerenal origin. Mortality was 23.6%. It is necessary to warn patients taking metformin of the clinical situations potentially inducing AKI (especially dehydration).