Sterner Gunnar, Frid Anders
Dept of Nephrology, Malmö University Hospital - Malmö, Sweden - Nephrology Malmö, Sweden.
Dept of Endocrinology - Malmö, Sweden Dept of Endocrinology - Malmö, Sweden.
Lakartidningen. 2018 Apr 3;115:E397.
Metformin is eliminated through glomerular filtration and tubular secretion in the kidneys. New guidelines recommend use of metformin down to a GFR of 30 mL/min under the condition that the dose is adjusted. As the risk of inducing lactic acidosis is very low in connection with administration of iodine contrast media, new recommendations in Sweden say that metformin must be stopped only when GFR is below 45 mL/min. Determination of metformin levels in serum is useful to guide therapeutic dose when GFR is low but also to confirm that lactic acidosis is caused by metformin.
二甲双胍通过肾脏的肾小球滤过和肾小管分泌而被清除。新指南建议，在调整剂量的情况下，可将二甲双胍的使用下限降至肾小球滤过率（GFR）为30毫升/分钟。由于使用碘造影剂时诱发乳酸性酸中毒的风险非常低，瑞典的新建议指出，只有当GFR低于45毫升/分钟时才必须停用二甲双胍。当GFR较低时，测定血清中的二甲双胍水平有助于指导治疗剂量，同时也有助于确认乳酸性酸中毒是否由二甲双胍引起。
