Hur Kyu Yeon, Kim Mee Kyoung, Ko Seung Hyun, Han Miyeun, Lee Dong Won, Kwon Hyuk-Sang
Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Kidney Res Clin Pract. 2020 Mar 31;39(1):32-39. doi: 10.23876/j.krcp.20.012.
The safety of metformin use for patients with type 2 diabetes mellitus (T2DM) and advanced kidney disease is controversial, and more recent guidelines have suggested that metformin be used cautiously in this group until more definitive evidence concerning its safety is available. The Korean Diabetes Association and the Korean Society of Nephrology have agreed on consensus statements concerning metformin use for patients with T2DM and renal dysfunction, particularly when these patients undergo imaging studies using iodinated contrast media (ICM). Metformin can be used safely when the estimated glomerular filtration rate (eGFR) is ≥ 45 mL/min/1.73 m. If the eGFR is between 30 and 44 mL/min/1.73 m, metformin treatment should not be started. If metformin is already in use, a daily dose of ≤ 1,000 mg is recommended. Metformin is contraindicated when the eGFR is < 30 mL/min/1.73 m. Renal function should be evaluated prior to any ICM-related procedures. During procedures involving intravenous administration of ICM, metformin should be discontinued starting the day of the procedures and up to 48 hours post-procedures if the eGFR is < 60 mL/min/1.73 m.
二甲双胍用于2型糖尿病（T2DM）合并晚期肾病患者的安全性存在争议，最近的指南建议，在获得更多关于其安全性的确切证据之前，该组患者应谨慎使用二甲双胍。韩国糖尿病协会和韩国肾脏病学会已就有关二甲双胍用于T2DM合并肾功能不全患者的共识声明达成一致，特别是当这些患者接受使用碘化造影剂（ICM）的影像学检查时。当估计肾小球滤过率（eGFR）≥45 mL/min/1.73 m²时，二甲双胍可安全使用。如果eGFR在30至44 mL/min/1.73 m²之间，则不应开始使用二甲双胍治疗。如果已经在使用二甲双胍，建议每日剂量≤1000 mg。当eGFR<30 mL/min/1.73 m²时，禁用二甲双胍。在任何与ICM相关的操作之前，都应评估肾功能。在涉及静脉注射ICM的操作过程中，如果eGFR<60 mL/min/1.73 m²，应在操作当天开始停用二甲双胍，并持续至操作后48小时。
