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Is Metformin Bad For Your Kidneys

Drinking Alcohol When Taking Metformin Can Lead To Serious Side Effects

Metformin Damages Kidneys?

Drinking excessive amounts of alcohol while taking metformin is not safe at all and can raise your risk of experiencing lactic acidosis. This is because metformin and alcohol both cause lactic acid to build up in the blood. As discussed above, too much lactic acid in the body can make you very sick.

So when you drink alcohol excessively and take metformin, your risk of lactic acidosis goes up. As always, its best to stay within the recommended low-risk limits for alcohol consumption: no more than 7 drinks per week for people assigned female at birth , and no more than 14 drinks per week for people assigned male at birth .

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Sensitivity Analysis Of The Duration Of Metformin Administration

We additionally constructed a penalized spline to investigate the trend between the predicted risks of each outcome according to the duration of metformin administration. In the whole population without classification according to eGFR, the overall mortality rate was decreased in patients treated with metformin for more than 2.7 years, and the ESRD progression rate decreased in patients treated with metformin for more than 2.5 years . When a subgroup analysis stratified by an eGFR of 30 mL/min/1.73 m2 and 45 mL/min/1.73 m2 was performed, longer metformin usage was associated with a lower risk of all-cause mortality and ESRD progression, with the exception of the risk of ESRD progression in the group with an eGFR < 30 mL/min/1.73 m2. Additionally, patients with more advanced CKD tended to experience more benefit from a shorter metformin treatment duration in both primary outcomes. The correlations between the daily mean metformin dose and the predicted risks of all-cause mortality and ESRD progression are presented in Supplementary Fig. 6.

Metformin In People With Kidney Disease

Just over one year ago here at Diabetes Flashpoints,we discussed the possibility that hundreds of thousands of people with both diabetes and kidney disease might benefit from taking the diabetes drug metformin. As we noted then, this drug has carried a black box warning on its label mandated by the U.S. Food and Drug Administration ever since it became available in the United States in 1994, due to concerns about lactic acidosis. This rare but extremely serious reaction was found to be an unacceptably common side effect of a drug related to metformin phenformin which was pulled from the U.S. market in 1977. Lactic acidosis is much more common in people with impaired kidney function.

Since metformins warning label is based, in part, on concerns about a different drug entirely, many researchers have tried to estimate how safe metformin is for people with diabetes whose kidney function is impaired. Last year, we noted that many researchers believe metformin is safe for people with mild to moderate kidney disease, defined as having an estimated glomerular filtration rate of 3060 ml/min. And one study found that using a safety cutoff of an eGFR of 30 ml/min, nearly one million people in the United States who currently dont take metformin because of the FDAs labeling might be able to safely do so.

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Does Metformin Cause Heart Attacks Or Is It Good For The Heart

Metformin does not cause heart attacks, and it appears to decrease cardiovascular events in specific populations.

In the United Kingdom Prospective Diabetes Study , obese patients who were assigned initially to receive metformin rather than sulfonylurea or insulin therapy had a decreased risk of heart attacks and mortality. In another trial, 390 patients treated with insulin were randomly assigned to metformin versus placebo After four years, average A1C and body weight were significantly lower in the metformin group. Also, there was a decrease in the risk of heart attacks. In other observational studies, metformin showed lower long-term cardiovascular mortality compared with a sulfonylurea .

Metformin May Be Of Benefit Even In Advancing Kidney Disease

Can Metformin Cause Kidney Failure?

Nancy A. Melville

The use of metformin among people with type 2 diabetes who have chronic kidney disease is associated with a reduced risk of death and end-stage renal disease without increasing the risk of lactic acidosis a new observational study from South Korea shows.

âIn patients with advanced CKD, if metformin is used carefully while monitoring, it could be suggested as a treatment that can slow the progress of kidney disease as well as cardiovascular benefit,â lead author Jung Pyo Lee, MD, PhD, of Seoul National University Boramae Medical Center, told Medscape Medical News.

In recent years, guidance from the US Food and Drug Administration has recommended relaxation of metformin use in patients with type 2 diabetes and CKD, but only for those with less severe renal disease. Concerns about its use center on the perceived risk of lactic acidosis with the agent.

So for those with moderate CKD stage 3B disease , metformin use still âremains controversial,â say the Korean researchers, led by Soie Kwon, of Seoul National University Hospital, writing in Diabetes Care.

And avoidance of metformin is still advised for those with very poor kidney function .

Now these new results âsupport a recent trend that metformin can be considered in CKD 3B patients because of its association with decreasing all-cause mortality and delaying ESRD progression and because of its association with a low incidence of lactic acidosis,â Kwon and colleagues note.

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Metformin And Vitamin B12 Deficiency

The association between long-term use of metformin and low vitamin B12 levels in type 2 diabetes mellitus patients is well-established. This is thought to be due to changes in the production of intrinsic factor in the stomach, which decreases vitamin B12 absorption in the intestine. Vitamin B12 deficiency is more pronounced if the patient is also taking a proton pump inhibitor such as omeprazole or histamine H2 receptor antagonist such as famotidine, which are medications used to treat acid reflux. Since diabetes can cause peripheral neuropathy, as well as vitamin B12 deficiency can cause peripheral neuropathy, it can be confusing for diabetic patients on metformin and their practitioners.

Therefore, patients using metformin for a prolonged period should be screened initially and periodically for vitamin B12 deficiency. In addition, there is also growing evidence that other B vitamins, vitamin D, and magnesium can be impacted by metformin.

Systematic review evaluates benefits and harms of metformin use in people with diabetes and CKD.

Q: Why did the U.S. Food and Drug Administration add a boxed warning about metformin use in people with CKD when it approved the medication in 1994?

Q: How has the FDA changed the boxed warning about metformin use in people with CKD?

What About Pancreas Transplants

Sometimes it is possible to perform a pancreas transplant along with a kidney transplant. Your doctor can advise you about this possibility.

Today, more and more research dollars are spent on diabetes research. Hopefully, the prevention and cure of diabetes are in the future.

In the meantime, you can manage your diabetes better with:

  • home monitoring of your blood glucose levels
  • maintaining an awareness of controlling your blood pressure, and possibly monitoring your pressure at home
  • following your special diet.

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Glycaemic Control After Metformin Discontinuation In Diabetic Patients With A Declining Renal Function

Chin Meng Khoo

1Department of Medicine, National University Hospital, Singapore

2Yong Loo Lin School of Medicine, National University of Singapore, Singapore

3Higher Education Department, Centre for International Education, Cebu, Philippines

Abstract

1. Introduction

The rising prevalence of type 2 diabetes mellitus is considered one of the most challenging public health problems. More than 400 million people will be affected by T2DM by the year 2030, with the greatest increase expected in Asian populations . Metformin is the recommended first-line antidiabetic therapy for all patients in addition to lifestyle change. Metformin is a very effective antidiabetic agent, widely available and affordable. Its most common side effect is gastrointestinal irritation. T2DM is associated with dismal micro- and macrovascular complications. One of the most dreadful microvascular complications is diabetic nephropathy, which is often characterised by declining estimated glomerular filtration rate and proteinuria. Declining renal function prohibits many medications for fear of potential side effects from lower renal clearance. As such, it is recommended that metformin should be discontinued when the eGFR falls to 30ml/minute/1.73m2 or below , in anticipation of a higher risk of lactic acidosis. Other antidiabetic agents including sulfonylureas, meglitinides, dipeptidyl peptidase-4 inhibitors, and insulin have been shown to be safe in patients with declining renal function .

3. Results

N

Sensitivity Analysis Of Glycemic Control

Is Metformin Safe For Kidney Disease? Metformin & Kidney Disease Question!

Because glycemic control can affect patient outcomes, we conducted two sensitivity analyses of glycemic control. First, we adjusted HbA1c levels as a time-varying covariate based on a fully adjusted multivariate Cox regression model. Metformin users with an eGFR > 30 mL/min/1.73 m2 still had low all-cause mortality and low ESRD incidence .

Second, we investigated severe hypoglycemic events that caused an emergency department visit. A total of 535 events were recorded in the whole cohort, and 294 events were recorded in the PSM cohort. Metformin did not increase the number of severe hypoglycemic events for either the whole population or the PSM cohort .

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Metformin Doses To Ensure Efficacy And Safety In Patients With Reduced Kidney Function

  • Contributed equally to this work with: Isabelle H. S. Kuan, Daniel F. B. Wright

    Roles Formal analysis, Software, Writing original draft, Writing review & editing

    Affiliation School of Pharmacy, University of Otago, Dunedin, New Zealand

  • Roles Data curation, Formal analysis, Investigation, Writing review & editing

    Affiliation Department of Medicine, University of Otago, Dunedin, New Zealand

  • Roles Formal analysis, Investigation, Writing review & editing

    Affiliation Department of Medicine, University of Otago, Dunedin, New Zealand

  • Roles Formal analysis, Investigation, Writing review & editing

    Affiliation Department of Medicine, University of Otago, Dunedin, New Zealand

  • Roles Conceptualization, Data curation, Investigation, Writing review & editing

    Affiliation Department of Medicine, University of Otago, Dunedin, New Zealand

Data Isolation And Quality Assessment

Two investigators independently extracted all information of interest in standardized form, including demographic characteristics of patients , stage of CKD, duration of DM, and follow-up duration. Other data of concern included study information , type, intervention, and clinical outcomes , analysis scheme , and effect levels . We acquired effect estimates from models with minimal or full adjustment and reporting the adjusting variables.

The quality of each p-h/sa of RCT or OS was assessed by Y.H. and M.L. with a 9-star NewcastleOttawa scale , and high quality was implied by a score > 6 stars. The evidence quality of each outcome among the enrolled articles was assessed as deficient, low, modest or high by YH and ML independently according to Grading of Recommended Assessment, Development and Evaluation . Any inconsistency between them was addressed via discussion.

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Does Metformin Cause Acute Kidney Injury

For many years clinicians have been avoiding the use of metformin in kidney patients and specifically in those with diabetes. This is fueled by the FDA warning about the use of metformin in these patients due to concerns about lactic acidosis . The original FDA warning was much more strict, but the more recent one issued in 2016 weighed in with more detail about metformin and kidney function. The new warning allows metformin to be used in patients who have worse kidney function. The newest warning indicates metformin can be used in patients who have an estimated glomerular filtration rate greater than 45 mL/min. Furthermore, metformin can continue to be used in existing patients whose eGFR remains over 30 mL/min.As you saw from the survey, many primary care physicians and other specialists think that metformin can cause direct acute kidney injury. However, the literature shows that metformin can be protective in kidney disease. There is absolutely no evidence that metformin can lead to kidney injury. In fact, there is evidence to the contrary.

How To Tolerate Metformin

Stopping metformin: Side effects, risks, and how to stop safely

Some patients may have gastrointestinal intolerance to metformin such diarrhea and bloating. In these patients, slower titration, ensuring that the patient is taking the medication with food, or switching to an extended-release formulation may improve tolerability. Extended-release metformin Extended-release metformin, typically taken once daily with the evening meal, is available in 500 and 750 mg tablets. For our patients having tolerance problems, we sometimes give the entire dose up to 2000 mg at once at the dinner meal. Because patients take metformin with meals, the ability to administer the whole treatment once daily typically improves adherence.

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Lactic Acidosis: A Rare But Serious Side Effect Of Metformin

Lactic acidosis is a very rare complication that can happen when taking metformin. Lactic acid is a substance our bodies use to create glucose . Metformin, in part, helps prevent the creation of glucose, so this can lead to a buildup of lactic acid in the blood.

Lactic acidosis is when lactic acid levels get too high and it can be fatal if left untreated. This is a medical emergency that needs immediate hospital care. Signs of lactic acidosis include:

  • Trouble breathing

  • Muscle aches

  • Stomach pain

Lactic acidosis rarely happens unless a person has taken too much of metformin. Other conditions or situations that put you at risk of experiencing lactic acidosis with metformin are:

Your risk is also higher if you are very unwell and in the hospital with:

  • Pneumonia

  • Another serious infection

Its important to keep up to date with all bloodwork that your healthcare provider orders. This will help them monitor things like kidney and liver health, keeping your risk of lactic acidosis as low as possible.

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How Should This Medicine Be Used

Metformin comes as a liquid, a tablet, and an extended-release tablet to take by mouth. The liquid is usually taken with meals one or two times a day. The regular tablet is usually taken with meals two or three times a day. The extended-release tablet is usually taken once daily with the evening meal. To help you remember to take metformin, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take metformin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow metformin extended-release tablets whole do not split, chew, or crush them.

Your doctor may start you on a low dose of metformin and gradually increase your dose not more often than once every 1â2 weeks. You will need to monitor your blood sugar carefully so your doctor will be able to tell how well metformin is working.

Metformin controls diabetes but does not cure it. Continue to take metformin even if you feel well. Do not stop taking metformin without talking to your doctor.

Ask your pharmacist or doctor for a copy of the manufacturerâs information for the patient.

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Managing The Side Effects Of Metformin

Most of the common side effects of metformin involve your digestive system. You can minimize your chances of developing side effects by:

  • Starting with a low dose. Its best to start at a low dose and work up over time to reduce the chances of developing side effects. A typical starting dose is 500 milligrams.
  • Taking metformin with a meal. Taking metformin with a meal can help reduce your chances of developing an upset stomach or gastric discomfort.
  • Taking extended-release metformin. You can talk with a doctor to see if extended-release metformin might be right for you. This type of metformin releases slowly over time and typically has milder side effects. Be sure to discuss the FDA recall of certain brands of metformin extended release, to ensure youre getting a safe version.
  • Taking pills whole. You shouldnt crush up pills. Doing so can speed up the rate that theyre absorbed.

If you develop uncomfortable side effects, its a good idea to contact your doctor. They may recommend changing the dosage of the type of metformin youre taking. You may find that you need to change your dosage, particularly during periods of stress.

Its also a good idea to avoid drinking heavily when taking metformin because it can increase your chances of developing lactic acidosis.

Several factors raise your risk of lactic acidosis while taking metformin. If any of these factors affect you, be sure to discuss them with your doctor before taking this drug.

How Are The Kidneys Kept Working As Long As Possible

Metformin side effects, is it bad for you? Doctor explain! SugarMD

The kidney doctor, called a nephrologist, will plan your treatment with you, your family and your dietitian. Two things to keep in mind for keeping your kidneys healthy are controlling high blood pressure in conjunction with an ACE inhibitor and following your renal diabetic diet. Restricting protein in your diet also might be helpful. You and your dietitian can plan your diet together.

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What Medicines Might I Consider Diabetes

The medication you take will vary by your type of diabetes and how well the medicine controls your blood sugar levels, likewise called blood sugar level. Other factors, such as your other health conditions, medication expenses, and your daily schedule might contribute in exactly what diabetes medication you take.

Are There Different Types Of Diabetes

The most common ones are Type 1 and Type 2. Type 1 diabetes usually occurs in children. It is also called juvenile onset diabetes mellitus or insulin-dependent diabetes mellitus. In this type, your pancreas does not make enough insulin and you have to take insulin injections for the rest of your life.

Type 2 diabetes, which is more common, usually occurs in people over 40 and is called adult-onset diabetes mellitus. It is also called non-insulin-dependent diabetes mellitus. In Type 2, your pancreas makes insulin, but your body does not use it properly. The high blood sugar level often can be controlled by following a diet and/or taking medication, although some patients must take insulin. Type 2 diabetes is particularly prevalent among African Americans, American Indians, Latin Americans, and Asian Americans.

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