Department of General and Specialist Medicine, Nephrology, Dialysis and Transplantation U, CTO Hospital, Torino, Italy.
Blood Purif. 2017;44(3):198-205. doi: 10.1159/000471917. Epub 2017 Jul 1.
Metformin-associated lactic acidosis (MALA) is a severe complication of drug administration with significant morbidity and mortality. So far no study in large population areas have examined the incidence, clinical profile and outcome of acute kidney injury (AKI)-MALA patients admitted in intensive care units (ICUs) and treated by renal replacement therapy (MALA-RRT).
Retrospective analysis over a 6-year period (2010-2015) in Piedmont and Aosta Valley regions (5,305,940 inhabitants, 141,174 diabetics treated with metformin) of all MALA-RRT cases.
One hundred and seventeen cases of AKI-MALA-RRT were observed (12.04/100,000 metformin treated diabetics, 1.45% of all RRT-ICU patients). Survival rate was 78.3%. The average duration of RRT was 4.0 days at mean dialysis effluent of 977 mL/kg/day. At admission most patients were dehydrated, and experienced shock and oliguria.
Our data showed that MALA-RRT is a common complication, needing more prevention. Adopted policy of early, extended, continuous and high efficiency dialysis could contribute to an observed high survival rate. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi=471917.
二甲双胍相关性乳酸酸中毒（MALA）是药物治疗的严重并发症，具有较高的发病率和死亡率。目前，还没有研究在大人群地区调查 ICU 中接受肾脏替代治疗（MALA-RRT）的急性肾损伤（AKI）-MALA 患者的发病率、临床特征和结局。
回顾性分析了皮埃蒙特和奥斯塔山谷地区（5305940 居民，141174 名接受二甲双胍治疗的糖尿病患者）6 年来（2010-2015 年）所有 MALA-RRT 病例。
共观察到 117 例 AKI-MALA-RRT 患者（12.04/100000 名接受二甲双胍治疗的糖尿病患者，占所有 RRT-ICU 患者的 1.45%）。存活率为 78.3%。RRT 的平均持续时间为 4.0 天，平均透析流出量为 977 mL/kg/天。入院时，大多数患者出现脱水、休克和少尿。
我们的数据表明，MALA-RRT 是一种常见的并发症，需要更多的预防措施。采用早期、延长、持续和高效透析的策略可能有助于观察到的高存活率。
