Chronic kidney diseases, metformin and lactic acidosis

Czech version

Authors: Zoltán Borbély ^1,2
Authors‘ workplace: Klinika vnútorného lekárstva I. FNsP Nové Zámky, Slovenská republika ¹; Vysoká škola zdravotníctva a sociálnej práce sv. Alžbety, Bratislava, Slovenská republika ²
Published in: Vnitř Lék 2016; 62(4): 299-303
Category: Reviews

Overview

Chronic kidney disease and diabetes mellitus represent a worldwide public health problem. The incidence of these diseases is gradually growing into epidemic proportions. In many cases they occur simultaneously, what leads to increased morbidity and mortality among the affected patients. The majority of the patients treated for diabetes mellitus are unaware of the presence of renal insufficiency. Vascular hypertrophy and diabetic kidney disease in patients with type 2 diabetes are the most common causes of kidney failure in countries with advanced healthcare systems. Metformin is a basic drug used for the treatment of type 2 diabetes mellitus. It is excreted in an unchanged form by the kidneys. When administered to patients with renal insufficiency, sepsis, dehydration or after the parenteral administration of iodinated contrast agents, metformin can cause lactic acidosis, which is also associated with an increased mortality rate.

Key words:
diabetes mellitus – chronic kidney disease – lactic acidosis – metformin

Sources

1. Okša A, Ponťuch P, Martinka E et al. Diabetická nefropatia – diagnostika, prevencia a liečba. Odporúčané postupy Slovenskej nefrologickej spoločnosti a Slovenskej diabetologickej spoločnosti. Diabetes a obezita 2012; 12(24): 101–107.

2. Pilmore HL. Review: metformin: potential benefits and use in chronic kidney disease. Nephrology (Carlton) 2010; 15(4): 412- 418.

3. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl 2013; 3(1): 1–150. Dostupné z WWW: http://www.kdigo.org/clinical_practice_guidelines/pdf/CKD/KDIGO_2012_CKD_GL.pdf.

4. Viklický O, Sulková S, Rychlík I et al. Klasifikace chronických onemocnění ledvin a predialýza. In: Viklický O et al. Predialýza. Maxdorf: Praha 2013: 14–21. ISBN: 9788073453565.

5. Odborné usmernenie Ministerstva zdravotníctva Slovenskej republiky na poskytovanie zdravotnej starostlivosti pacientom s diabetickou nefropatiou. Vestnik MZ SR 2014; 62. Čiastka 27–32: 176–185. Dostupné z WWW: http://www.nefro.sk/fileadmin/Nefro/Legislativa/Odborne_usmernenie_MZSR_na_poskytovanie_zdravotnej_starostlivosti_pacientom_s_diabetickou_nefropatiou.pdf.

6. Haluzík M. Liečba diabetu u pacientů s onemocnením jater a ledvin. Vnitř Lék 2015; 61(4): 304–311.

7. Perušičová J. Proč je metformin lékem první volby pro nemocné s diabetes mellitus 2.typu? Interní Med 2010; 12(7–8): 385–386. Dostupné z WWW: http://www.internimedicina.cz/pdfs/int/2010/07/12.pdf.

8. Vecchio S, Protti A. Metformin-induced lactic acidosis: no one behind. Critical Care 2011; 15(1): 107.

9. Kalchko D, Whaley-Conell A. Use of Metformin in Patients with Kidney and Cardiovascular Diseases. Cardiorenal Medicine 2011; 1(2): 87–95.

10. Galková K. Laktát – marker metabolického stresu pacientov s kritickým ochorením. Anesteziol Intenzivna Med 2015; 4(1): 8–11

11. Šmahelová A. Metformin a ledviny. Vnitř Lék 2008; 54(5): 535–540.

12. Al-Hwiesh AK, Abdul-Rahman IS, El-Deen MA et al. Metformin in peritoneal dialysis: a pilot experience. Perit Dial Int 2014; 34(4): 368–375.

13. Vecchio S, Giampreti A, Petrolini VM et al. Metformin accumulation: lactic acidosis and high plasmatic metformin levels in a retrospective case series of 66 patients on chronic therapy. Clin Toxicol (Phila) 2014; 52(2): 129–135.

14. Salpeter SR, Greyber E, Pasternak GE et al. Risk of fatal and nonfatal lactic acidosis with methormin use in type 2 diabetes mellitus. Cochrane Database Syst Rev 2010; (4):CD002967. Dostupné z DOI: http://dx.doi.org/10.1002/14651858.CD002967.pub4.

15. Ncomanzi D, Sicat R, Sundararajan K. Metformin- associated lactic acidosis presenting as an ischemic gut in a patient who then survived a cardiac arrest. J MED Case Report 2014; 8: 159. Dostupné z DOI: <http://dx.doi.org/10.1186/1752–1947–8-159>.

16. Schück O. Poruchy metabolismu vody a elektrolytů. In: Tesař V, Schück O et al. Klinická nefrologie. Grada: Praha 2006: 157. ISBN: 8024711222.

17. Lalau JD. Lactic acidosis induced by metformin: incidence, management and prevention. Drug Saf 2010; 33(9): 727–740.