Department of Nephrology, Kasturba Medical College and Hospital Manipal, Manipal Academy Higher Education, Madhav Nagar, Manipal, Udupi, Karnataka, 576104, India.
Department of Statistics, Prasanna School of Public Health, MAHE, Udupi, India.
Int Urol Nephrol. 2019 Jul;51(7):1229-1230. doi: 10.1007/s11255-019-02136-y. Epub 2019 Apr 8.
To study the incidence of lactic acidosis due to metformin in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) stage 3-5.
We estimated plasma lactate in patients of CKD stage 3 and worse who were continuing metformin on their own prior to stopping the drug.
Of 40 patients included, median duration of T2DM was 60 months (interquartile range IQR 24-120). The mean serum creatinine was 309.4 ± 159.1 µmol/L and mean eGFR was 27.82 ± 12.93 mL/min/1.73 m with 3 (7.5%), 16 (40%), 11 (27.5%) and 10 (25%) in CKD stages 3a, 3b, 4 and 5, respectively. They were receiving metformin for a median duration of 24 months (IQR 12.5-60), an average dose of 896 ± 350 mg per day. The median of plasma lactate was 1.36 mmol/L (IQR 1.11-1.75 mmol/L) with three (7.5%) having levels above normal, two (20%) in CKD stage 5 and one (9.1%) in stage 4.
Metformin can be safely used in CKD stage 3 and with regular measurement of plasma lactate in later stages.
研究 2 型糖尿病（T2DM）合并 3-5 期慢性肾脏病（CKD）患者中二甲双胍引起的乳酸酸中毒发生率。
我们估计了正在自行服用二甲双胍且 CKD 分期在 3 期及以上的患者的血浆乳酸水平，然后再停用该药。
40 例患者中，T2DM 的中位病程为 60 个月（四分位距 IQR 24-120）。平均血清肌酐为 309.4±159.1μmol/L，平均 eGFR 为 27.82±12.93mL/min/1.73m，分别有 3（7.5%）、16（40%）、11（27.5%）和 10（25%）例患者处于 CKD 3a、3b、4 和 5 期。他们服用二甲双胍的中位时间为 24 个月（IQR 12.5-60），平均剂量为 896±350mg/天。血浆乳酸中位数为 1.36mmol/L（IQR 1.11-1.75mmol/L），其中 3 例（7.5%）高于正常值，2 例（20%）在 CKD 5 期，1 例（9.1%）在 CKD 4 期。
在 CKD 3 期可以安全使用二甲双胍，在后期应定期测量血浆乳酸。
