Department of Diabetes, Barts and the London School of Medicine and Dentistry, The Royal London Hospital, London, UK.
Department of Nephrology, Pondicherry Institute of Medical Sciences, Madras Medical Mission, Chennai, India.
Diabetes Obes Metab. 2017 Feb;19(2):156-161. doi: 10.1111/dom.12799. Epub 2016 Nov 9.
Diabetes is an important cause of end stage renal failure worldwide. As renal impairment progresses, managing hyperglycaemia can prove increasingly challenging, as many medications are contra-indicated in moderate to severe renal impairment. Whilst evidence for tight glycaemic control reducing progression to renal failure in patients with established renal disease is limited, poor glycaemic control is not desirable, and is likely to lead to progressive complications. Metformin is a first-line therapy in patients with Type 2 diabetes, as it appears to be effective in reducing diabetes related end points and mortality in overweight patients. Cessation of metformin in patients with progressive renal disease may not only lead to deterioration in glucose control, but also to loss of protection from cardiovascular disease in a cohort of patients at particularly high risk. We advocate the need for further study to determine the role of metformin in patients with severe renal disease (chronic kidney disease stage 4-5), as well as patients on dialysis, or pre-/peri-renal transplantation. We explore possible roles of metformin in these circumstances, and suggest potential key areas for further study.
糖尿病是全球范围内导致终末期肾衰竭的一个重要原因。随着肾功能的逐渐恶化，控制高血糖可能会变得越来越具有挑战性，因为许多药物在中度至重度肾功能不全时是禁忌的。虽然严格控制血糖可以减少已确诊肾病患者进展为肾衰竭的证据有限，但控制不佳的血糖并不理想，可能会导致进行性并发症。二甲双胍是 2 型糖尿病患者的一线治疗药物，因为它似乎在降低超重患者的糖尿病相关终点和死亡率方面有效。对于肾功能逐渐恶化的患者，停止使用二甲双胍不仅可能导致血糖控制恶化，而且还可能使心血管疾病的保护作用丧失，因为这些患者处于极高风险之中。我们主张需要进一步研究来确定二甲双胍在严重肾功能疾病（慢性肾脏病 4-5 期）患者以及透析患者或肾前/肾移植患者中的作用。我们探讨了二甲双胍在这些情况下的可能作用，并提出了进一步研究的潜在重点领域。
