Recent guidelines governing anti-diabetic medications increasingly advocate Metformin as first-line therapy in all patients with type 2 diabetes. However, Metformin could be associated with increased risk of acute kidney injury ( AKI ), acute dialysis, and lactate acidosis in marginal patients.
In a retrospective nationwide cohort study, a total of 168,443 drug-naïve patients with type 2 diabetes greater than or equal to 50 years initiating treatment with either Metformin or sulphonyl in Denmark between 2000 and 2012 were included ( 70.7% initiated treatment with Metformin ), and one-year risk of acute dialysis was calculated based on g-standardization of cause-specific Cox regression models for acute dialysis, end-stage renal disease, and death.
One-year risks of acute dialysis were 92.4 per 100,000 ( 95% CI 67.1 – 121.3 ) and 142.7 per 100,000 ( 95% CI 118.3 – 168.0 ), for sulphonylurea and Metformin, respectively.
The metformin-associated one-year risk of acute dialysis was increased by 50.3 per 100,000 ( 95% CI 7.9 – 88.6 ), corresponding to a risk ratio of 1.53 ( 95% CI 1.06 – 2.23 ), and a number needed to harm of 1988; thus providing evidence of potential concerns pertaining to the increasing use of Metformin. ( Xagena )
Carlson N et al, Diabetes Obes Metab 2016 ; Epub ahead of print