August 21, 2015

With Chronic Kidney Disease, Stop Metformin

A recent study reported a significant increase in all-cause mortality associated with the use of metformin in patients with type 2 diabetes. Yes, I can believe this as I have been taken off metformin recently because my kidney disease was moving closer to stage 3 and my doctor said to stop immediately. It will be interesting to see if there is improvement at my next appointment in late October.

Metformin is currently recommended as first line treatment for type 2 diabetes. However, its use is often limited in patients with chronic kidney disease stage 3 or higher due to the risk of lactic acidosis. I have not had any symptoms of lactic acidosis and feel fortunate for that. Since I will only use metformin and insulin, I was disappointed in having metformin removed as it had been helping me maintain and lose some weight.

The study took place in Taiwan, which allows metformin to be used in all stages of chronic kidney disease. Other countries in the world vary to greater extent and this allowed for this study to be more accurate. The finding of this study confirmed that metformin is associated with higher death rate among type 2 diabetes patient with higher stage of chronic kidney diseases.

My doctor did ask if I would consider using another oral medication or an injectable medication along with my insulin. I was very firm that I would not and going forward, I would rely on insulin only. She said that would be best and agreed with me. What I did not say is that I would not until it was proven that some of the side effects have been proven not to be harmful.

For metformin, the increased mortality risk was associated with higher dose and remained consistent across all subgroups. Finally, metformin users did not differ significantly from non-metformin users group in regard to risk of metabolic acidosis.

This study did confirm that metformin is associated with a higher death rate among type 2 diabetes patient with higher stage of chronic kidney diseases.
The study findings have therapeutic implications, supporting the current recommendations that metformin should not be used in patients with stage 5 chronic kidney disease.

In addition, the researchers also recommended future study evaluating the use of metformin in patients with less severe chronic kidney disease.

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