Department of Renal Medicine, Auckland City Hospital and University of Auckland, Auckland, New Zealand.
Nephrology (Carlton). 2010 Jun;15(4):412-8. doi: 10.1111/j.1440-1797.2010.01328.x.
Diabetes mellitus is the commonest cause of end-stage renal failure in both Australia and New Zealand. In addition, the burden of diabetes is prominent in those with chronic kidney disease who have not yet reached the requirement for renal replacement therapy. While diabetes is associated with a higher incidence of mortality and morbidity in all populations studied with kidney disease, little is known about optimal treatment strategies for hyperglycaemia and the effects of glycaemic treatment in this large group of patients. Metformin is recommended as the drug of first choice in patients diagnosed with type 2 diabetes in the USA, Europe and Australia. There are potential survival benefits associated with the use of metformin in additional to recent studies suggesting benefits in respect to cardiovascular outcomes and metabolic parameters. The use of metformin has been limited in patients with renal disease because of the perceived risk of lactic acidosis; however, it is likely that use of this drug would be beneficial in many with chronic kidney disease. Thus the potential benefits and harms of metformin are outlined in this review with suggestions for its clinical use in those with kidney disease.
糖尿病是澳大利亚和新西兰终末期肾衰竭的最常见病因。此外，在尚未需要肾脏替代治疗的慢性肾脏病患者中，糖尿病的负担也很突出。虽然在所有研究的肾脏病患者中，糖尿病与更高的死亡率和发病率相关，但对于该大组患者的高血糖最佳治疗策略及其血糖治疗效果知之甚少。在美国、欧洲和澳大利亚，二甲双胍被推荐作为诊断为 2 型糖尿病患者的首选药物。除了最近的研究表明在心血管结局和代谢参数方面有获益之外，使用二甲双胍还与生存获益相关。由于担心乳酸酸中毒，二甲双胍在有肾脏疾病的患者中的使用受到限制；然而，对于许多慢性肾脏病患者来说，使用这种药物可能是有益的。因此，本文综述了二甲双胍的潜在益处和危害，并就其在肾脏病患者中的临床应用提出了建议。
