Xu Qinhui, Huang Weixing, Li Qianyun, Bao Tongan, Luo Hua, Luo Xiao
Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China.
General Surgical Department, Taizhou Hospital of Zhejiang Province, Zhejiang University, Taizhou, Zhejiang, China.
Front Med (Lausanne). 2025 Jun 26;12:1547725. doi: 10.3389/fmed.2025.1547725. eCollection 2025.
Our study aimed to determine through a meta-analysis whether continuing metformin use in diabetic patients receiving contrast agents would increase the risk of renal impairment and metabolic abnormalities.
We searched the PubMed, EBSCO, Medline, and the Cochrane Central Register of Controlled Trials from the inception dates to March 2024. The included studies comparing metformin users and non-users during contrast agent administration in diabetic patients. Outcome measures included contrast-induced acute kidney injury (CI-AKI), serum creatinine, estimated glomerular filtration rate (eGFR), lactate level, and incidence of metabolic acidosis. We used odds ratio (OR) for dichotomous outcomes and weighted or standardized mean difference (WMD or SMD) for continuous outcomes, depending on scale consistency across studies.
Analysis involved 2 randomized controlled trials and 5 retrospective cohorts comprising 2020 patients. There were no significant differences between the metformin and non-metformin groups in CI-AKI incidence (OR: 0.87, 95% CI: 0.63-1.20), changes in renal function (serum creatinine: SMD: -0.15, 95% CI: -0.64-0.35; eGFR: WMD: 3.35, 95% CI: -1.60-8.29), incidence of metabolic acidosis (OR: 0.90, 95% CI: 0.57-1.43), and lactate levels (SMD: 0.29, 95% CI: -0.53-1.11). Sensitivity analysis excluding one study revealed a significant reduction in creatinine with metformin. Logistic regression meta-analysis showed that metformin use was not significantly associated with CI-AKI or metabolic acidosis, while contrast volume was the only consistent predictor of CI-AKI. Lower baseline CO was independently associated with increased risk of metabolic acidosis.
Our analysis indicates that continuing metformin during contrast agent administration does not increase the risk of CI-AKI, acidosis, or eGFR compared to discontinuation or non-use of metformin. Additionally, continuation of metformin may be associated with a modest reduction in serum creatinine levels after contrast exposure. However, the limited quality of included studies may weaken the strength of these conclusions.
https://www.crd.york.ac.uk/PROSPERO/view/CRD42023459602, identifier: CRD42023459602.
我们的研究旨在通过荟萃分析确定，在接受造影剂的糖尿病患者中继续使用二甲双胍是否会增加肾功能损害和代谢异常的风险。
我们检索了从起始日期至2024年3月的PubMed、EBSCO、Medline以及Cochrane对照试验中央注册库。纳入的研究比较了糖尿病患者在使用造影剂期间二甲双胍使用者和非使用者的情况。结局指标包括造影剂诱发的急性肾损伤（CI-AKI）、血清肌酐、估计肾小球滤过率（eGFR）、乳酸水平以及代谢性酸中毒的发生率。根据各研究间的量表一致性，对于二分结局我们使用比值比（OR），对于连续结局我们使用加权或标准化均数差（WMD或SMD）。
分析涉及2项随机对照试验和5项回顾性队列研究，共2020例患者。二甲双胍组和非二甲双胍组在CI-AKI发生率（OR：0.87，95%可信区间：0.63 - 1.20）、肾功能变化（血清肌酐：SMD：-0.15，95%可信区间：-0.64 - 0.35；eGFR：WMD：3.35，95%可信区间：-1.60 - 8.29）、代谢性酸中毒发生率（OR：0.90，95%可信区间：0.57 - 1.43）以及乳酸水平（SMD：0.29，95%可信区间：-0.53 - 1.11）方面均无显著差异。排除一项研究的敏感性分析显示，使用二甲双胍可使肌酐显著降低。逻辑回归荟萃分析表明，使用二甲双胍与CI-AKI或代谢性酸中毒无显著关联，而造影剂用量是CI-AKI唯一一致的预测因素。较低的基线CO与代谢性酸中毒风险增加独立相关。
我们的分析表明，与停用或不使用二甲双胍相比，在使用造影剂期间继续使用二甲双胍不会增加CI-AKI、酸中毒或eGFR的风险。此外，继续使用二甲双胍可能与造影剂暴露后血清肌酐水平适度降低有关。然而，纳入研究的质量有限可能会削弱这些结论的力度。
https://www.crd.york.ac.uk/PROSPERO/view/CRD\(42023459602\)，标识符：CRD42023459602。
