Division of Adult Endocrinology, Diabetes and Metabolism, and Hypertensive Diseases Unit, University of Chicago Hospitals, Chicago, IL 60637, USA.
Diabetes Obes Metab. 2010 Dec;12(12):1079-83. doi: 10.1111/j.1463-1326.2010.01295.x.
To show that metformin, one of the most widely used agents, is contraindicated in patients with diabetes having chronic kidney disease (CKD) (i.e. serum creatinine >1.5 mg/dl) secondary to fear of lactic acidosis. The overall incidence of lactic acidosis is estimated at an upper limit of eight cases per 100 000 patient-years. We evaluated metformin use in two cohorts, one from the University of Chicago Diabetes Center and the other from National Health and Nutrition Examination Survey (NHANES) 1999-2006.
Estimated glomerular filtration rate (eGFR) was calculated using the re-expressed Modification of Diet in Renal Disease (MDRD) Study equation and compared to serum creatinine. We hypothesized that metformin is used in patients with undetected advanced CKD (i.e. serum creatinine is ≥1.5 mg/dl). A chi-squared test was used to compare per cent differences of metformin use across demographic variables and eGFR in the NHANES cohort.
At the University of Chicago Diabetes Center, 36 of 234 (15.3%) patients with an eGFR of <60 ml/min/1.73 m(2) were receiving metformin. Data from NHANES, age >18 years and eGFR <60 ml/min/1.73 m(2) showed that Blacks with advanced nephropathy were three times more likely to receive metformin.
We conclude that metformin utilization occurs with a higher frequency than predicted by serum creatinine in people with eGFR <60 ml/min/1.73 m(2) . Given the very low incidence of lactic acidosis, the recommendation should be changed to reflect eGFR cut-off values rather than serum creatinine.
表明二甲双胍作为最常用的药物之一，在继发于乳酸酸中毒恐惧的患有慢性肾脏病（CKD）（即血清肌酐> 1.5mg/dl）的糖尿病患者中是禁忌的。乳酸酸中毒的总发生率估计上限为每 100000 患者年 8 例。我们评估了来自芝加哥大学糖尿病中心的一个队列和来自 1999-2006 年全国健康和营养检查调查（NHANES）的另一个队列中的二甲双胍使用情况。
使用重新表达的肾脏病饮食改良研究（MDRD）方程计算估计肾小球滤过率（eGFR），并与血清肌酐进行比较。我们假设二甲双胍用于未检测到的晚期 CKD 患者（即血清肌酐≥1.5mg/dl）。使用卡方检验比较 NHANES 队列中人口统计学变量和 eGFR 之间二甲双胍使用率的百分比差异。
在芝加哥大学糖尿病中心，234 名 eGFR<60ml/min/1.73m（2）的患者中有 36 名（15.3%）正在接受二甲双胍治疗。来自 NHANES 的数据，年龄>18 岁和 eGFR<60ml/min/1.73m（2）表明，晚期肾病的黑人接受二甲双胍的可能性是三倍。
我们得出的结论是，在 eGFR<60ml/min/1.73m（2）的人群中，二甲双胍的使用率高于血清肌酐预测的频率。鉴于乳酸酸中毒的发生率非常低，建议应根据 eGFR 截止值而不是血清肌酐进行更改。
