Is Metformin Safe For Kidneys

The Egfr Slope Determinants

eGFR was recorded in the metformin continuation group until the point of the metformin interruption or the end of the study period. In the metformin interruption group, eGFR was measured from at least 100 days after discontinuing metformin until the point of re-starting metformin treatment or December 31, 2013. The rate of renal function decline was determined according to the eGFR slope, and defined as the regression coefficient between eGFR and time in units of mL/min/1.73 m2/year, representing the change in the eGFR over time. At least four eGFR values were required to calculate the eGFR slope using regression coefficients between eGFR and time. A faster decline in renal function was indicated by a higher negative eGFR slope.

Emerging Data On Additional Metformin Benefits

Among type 2 diabetic patients who were newly prescribed metformin vs. other anti-diabetic drugs from the National Health Insurance reimbursement database in Taiwan, the incidence of kidney cancer among metformin users was substantially lower compared to non-users: 80 vs. 190 cases per 100,000 person-years, respectively . Furthermore, metformin use was associated with 72, 40, 72, and 90% lower risk of developing kidney cancer after < 14.5, 14.5-45.8, and > 45.8 months of follow-up compared to non-metformin users. These findings may have particular relevance in diabetic kidney disease patients, given the heightened risk of kidney cancer associated with CKD . Given the relatively low event rate of MALA observed in the aforementioned Hung et al. study, further studies are needed to determine whether the risks of metformin outweigh its potential benefits upon cancer risk and cardiovascular outcomes as shown in the UKPDS 34 study .

Metformin Is Bad For Your Kidneys

Its not. There may be some confusion here because up until 2016, patients with higher creatinine levelsa potential sign of kidney dysfunctionwere advised not to take metformin. But metformin, in fact, does not cause kidney problems, and that recommendation has since changed. Now, labels for metformin say that only patients with late-stage chronic kidney disease should not use the medication.

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Be Aware Of Low Blood Sugar

While the risk of severe hypoglycemia is low, it is possible, especially if you take multiple diabetes medications. Its always a good idea to have glucose tablets or gel with you just in case. These can help raise your blood sugar levels. Everyone experiences hypoglycemia in different ways, but common symptoms include:

• Shakiness

• Headache

Medications That Can Harm The Kidneys

No matter what kind of medicine you take, whether OTC or prescription, it is destined to take a trip through your kidneys. Taking a drug the wrong way or in excessive amounts can damage these vital, bean-shaped organs and lead to serious complications. In the worst-case scenario, it could necessitate a kidney transplant.

Compared with 30 years ago, patients todayhave a higher incidence of diabetes and cardiovascular disease, take multiple medications, and are exposed to more diagnostic and therapeutic procedures with the potential to harm kidney function, according to Cynthia A. Naughton, PharmD, senior associate dean and associate professor in the department of pharmacy practice at North Dakota State University. All of these factors are associated with an elevated risk of kidney damage.

An estimated 20% of cases of acute kidney failure are due to medications. The technical term for this scenario is nephrotoxicity, which is growing more common as the aging population grows, along with rates of various diseases.

The kidneys get rid of waste and extra fluid in the body by filtering the blood to produce urine. They also keep electrolyte levels balanced and make hormones that influence blood pressure, bone strength and the production of red blood cells. When something interferes with the kidneys, they cant do their job, so these functions can slow down or stop altogether.

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Metformin May Be Of Benefit Even In Advancing Kidney Disease

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.

“In 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,” 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 “remains controversial,” 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 “support 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,” Kwon and colleagues note.

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.

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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 .

Acidosis Related To Use Of Metformin Seen Only In Those With Severely Decreased Kidney Function

Date:

Johns Hopkins Medicine

Summary:

Results of a large-scale study suggest that the oral diabetes drug metformin is safe for most diabetics who also have chronic kidney disease . The study of more than 150,000 adults found that metformin’s association with the development of a life-threatening condition called lactic acidosis was seen only among patients with severely decreased kidney function.

Results of a large-scale study suggest that the oral diabetes drug metformin is safe for most diabetics who also have chronic kidney disease . The study of more than 150,000 adults by Johns Hopkins Medicine investigators found that metformin’s association with the development of a life-threatening condition called lactic acidosis was seen only among patients with severely decreased kidney function.

A report on the study appeared online June 4 in JAMA Internal Medicine.

The Food and Drug Administration recently revised its labeling of metformin so the drug could be used more by CKD patients, says Grams, and some regulatory and professional society guidelines cautiously support use of the drug by diabetic patients with moderate kidney disease. But data addressing the drug’s safety for patients with moderate to severe kidney disease had been inconclusive, she says.

However, metformin use was associated with an increased risk of acidosis at an eGFR level of less than 30 mL/min/1.73 m2.

Story Source:

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Metformin Type 2 Diabetes Mellitus And Advanced Chronic Kidney Disease

Globally, drug regulatory agencies have issued specific cautions and restrictions related to the use of metformin in patients with T2DM and advanced CKD. The concrete metabolic and cardiovascular benefits associated with metformin therapy derived from clinical and scientific evidence have encouraged some authors to extend the therapy options to patients with CKD Stage V, both in dialysis and conservative treatment.

Hung et al.47 conducted a retrospective observational cohort study on patients with T2DM and CKD Stage 5 using Taiwans National Health Insurance Research Database between 2000 and 2009. Approximately 8% of patients were using metformin despite contraindication and were matched at a ratio of 1:3 with nonusers by propensity score and followed-up for 2.1 years. After multivariate adjustment, metformin use was associated with a higher, but nonsignificant, risk of metabolic acidosis of 1.6 versus 1.3 events per 100 patient-years , and no dose correlation was observed .47 In patients using metformin, ESRD was significantly lower in comparison to the control group and metformin was associated with an increased mortality in a dose-dependent manner . After this study, the Taiwan National Health Insurance announced that metformin use was contraindicated in females and males with serum creatinine concentrations of > 1.5 and > 1.4 mg/dL, respectively.

Metformin Is Dangerous To Take During Pregnancy

This is not true. In fact, it may be the opposite. For example, one study found that metformin use during pregnancy in women with polycystic ovarian syndrome was associated with a reduced rate of miscarriage and gestational diabetes. Also good to know: The same study showed that taking metformin did not adversely affect the newborns birth weight or their development when the researchers followed up with them at 3 and 6 months of life.

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How Does Metformin Work

Metformins primary effect is to decrease glucose coming from the liver. It does that by reducing glucose production in the liver. Metformin also helps to increase glucose uptake by the cells, such as muscle and fat. That effect is more prominent, particularly after meals. Metformin also reduces the fat circulating in the bloodstream. As a result of these effects, metformin reduces insulin levels. There is also indirectly reduce his insulin resistance. Metformin also has a slight impact on appetite. It can help reduce the weight slightly. There are some suggestions that metformin can reduce the risk of cancer as well. Kidneys clear metformin. As a result, there is confusion about whether metformin is the cause of kidney damage.

Surgical Or Radiologic Procedures

If you plan to have surgery or a radiology procedure that uses iodine contrast, you should stop taking metformin 48 hours before the procedure.

These procedures can slow the removal of metformin from your body, raising your risk of lactic acidosis. You should resume taking metformin after the procedure only when your kidney function tests are normal.

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The Case Against Metformin

The main problem with metformin is its association with LA. Lactic acidosis is defined as an arterial lactate of > 5 mmol/L and a blood pH 7.35 . There are two forms of LA. Type A is anaerobic LA caused by lactate overproduction in order to regenerate adenosine triphosphate in the absence of oxygen, and is usually seen in the presence of circulatory collapse, e.g. heart failure, sepsis, and shock. Type B, the aerobic version, is caused by underutilization of lactate due to impaired removal by oxidation or gluconeogenesis, and is the type seen in liver disease, diabetes, cancer, and alcohol and metformin intoxication. Combinations of Type A & B are possible.

The therapeutic trough level for metformin is 0.7 mg/L . The pragmatic upper therapeutic limit is 5 mg/L .

Can Metformin Cause Kidney Problems

Actually, metformin is usually not the original cause of kidney problems. However, metformin is eliminated by the kidneys and when a patient has poor kidney function, the metformin can build up in the blood and cause a rare but serious condition called lactic acidosis. Lactic acidosis affects the chemistry balance of your blood and can lead to kidney failure and other organ failure. The risk of lactic acidosis is very low and most often occurs in patients with poor kidney function â so for most patients, the benefits of metformin outweigh the risks of treatment. Most doctors will regularly perform kidney function tests to make sure the kidney is working well in patients who are taking metformin. With that said, if you are taking metformin, contact your doctor immediately if you experience unexplained weakness, muscle pain, difficulty breathing, or increased drowsiness â these can be early signs of lactic acidosis. Also, if you are taking metformin and going to receive a radiocontrast dye study or have surgery, tell your doctors that you are taking metformin â in most cases, your doctor will instruct you to temporarily stop taking metformin during these procedures to help decrease the risk of lactic acidosis.

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Metformin Is Not Usually The Cause Of La

Diabetes mellitus per se disposes to hyperlactemia, the concentration of lactate being double the level of healthy controls , and physical exercise in untreated T2DM causes a 2.8 times increase in p-lactate, similar to metformin-treated patients . Ketoacidosis is commonly accompanied by LA . The increased LA rates seen in patients with heart failure can be related to poor circulation, and, in patients with hepatic failure, to reduced hepatic metabolism of lactate. A controlled investigation showed no increase in lactate concentration or turnover in metformin-treated patients .

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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Will Metformin Hurt Our Kidneys

Will metformin hurt our kidneys? This is a common question for diabetes patients. As we know, diabetes is one of the most common leading causes of kidney disease, the long-term uncontrolled high blood sugar will cause finally cause kidney disease. Metforimin is a common and effective western medicine for type 2 diabetes which can help control the high blood pressure, but some patients may be confused whether metformin will hurt kidneys or not.

Recently, a research shows that metformin will not cause kidney damage for people with normal kidney function, in turn it can help protect the kidneys. The metformin has the function of protecting kidneys by the increased levels of a molescule known as AMPK . The research concerned an adipokine, a hormone produced by fat cells, which is called adiponectin. Different from other substances produced by fat cells, adiponectin is good for people, which can help suppress inflammations and reduce the amount of protein in urine. Besides, the adiponectin can activate AMPD, and when the AMPD is stimulated, the kidney will stop leaking protein. In this aspect, we can find that metformin can help protect the kidney function for people who have healthy kidneys.

Besides, metformin can also cause side effects, such as gastrointestinal distress, which will affect peoples appetite. Patients can take metformin with meals, besides they can also take yogurt and milk thistle which can also remit their GI symptoms.

Drinking Alcohol When Taking Metformin Can Lead To Serious Side Effects

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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Weight Loss With Metformin

In individuals who are obese, metformin promotes mild to moderate weight reduction. Sometimes it helps with weight stabilization for patients continuously gaining weight. Compared us to weight gain often associated with insulin or sulfonylurea treatment. In one large study, for example, patients treated with glyburide gained an average of 4 lbs, whereas those receiving metformin lost 6 Ibs.

Effect Of Metformin On All

Mild/Moderate CKD

Six studies reported the effect of metformin use versus any other measure on all-cause mortality in patients with T2DM and mild/moderate CKD . The pooled RR was 0.71 in a random-effects model, with severe heterogeneity .

Figure 2 Forest plot of the risk of all-cause mortality in patients with type 1 diabetes mellitus and chronic kidney disease .

Sensitivity analysis uncovered that heterogeneity did not disappear after the deletion of single studies. Significant publication bias was found by Eggers test , but not by funnel plot inspection or Begg test . During publication bias exploration based on the trim-and-fill approach, the probable missing data were not replaced, so the results were basically equal to a remarkably less risk of all-cause death after metformin treatment . The GRADE determined a low-quality evidence that metformin prevented all-cause death in mild/modest CKD patients.

Advanced CKD

Six trails reported all-cause mortality in advanced CKD patients . Metformin use had no significant therapeutic effect on all-cause death , with heavy between-study heterogeneity . The effect was still insignificant in the stratified analysis by study design . The heterogeneity did not disappear after the exclusion of any single study.

The funnel plots showed no evident systematic bias between all-cause death and advanced CKD .

Moderate CKD

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