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Critical Care
Published in: Critical Care 1/2020

01-12-2020 | Acute Kidney Injury | Research Letter

Metformin use and early lactate levels in critically ill patients according to chronic and acute renal impairment

Authors: Rene A. Posma, Adam Hulman, Reimar W. Thomsen, Bente Jespersen, Maarten W. Nijsten, Christian F. Christiansen

Published in: Critical Care | Issue 1/2020

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Excerpt

Metformin is the most widely used oral antihyperglycemic agent. Because it is eliminated unmodified in urine, patients with renal insufficiency can accumulate metformin and may develop lactic acidosis [1]. Recent guidelines only restrict the use of metformin in patients with severe chronic kidney disease (CKD) because the benefit is considered larger than the risk for lactic acidosis [2]. Lactate measurement has a central role in identifying and monitoring critical illness [3]. A better understanding of the impact of metformin on lactate levels could improve clinical assessment of the critically ill. …
Literature
1.
Inzucchi SE, Lipska KJ, Mayo H, Bailey CJ, McGuire DK. Metformin in patients with type 2 diabetes and kidney disease: a systematic review. JAMA. 2014;312:2668–75.CrossRef
2.
Davies MJ, D'Alessio DA, Fradkin J, et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2018;41:2669–701.CrossRef
3.
Levy MM, Evans LE, Rhodes A. The Surviving Sepsis Campaign bundle: 2018 update. Crit Care Med. 2018;46(6):997–1000.CrossRef
4.
Posma RA, Frøslev T, Jespersen B, et al. Prognostic impact of elevated lactate levels on mortality in critically ill patients with and without preadmission metformin treatment: a Danish registry-based cohort study. Ann Intensive Care. 2020;10:36.CrossRef
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Siew ED, Ikizler TA, Matheny ME, et al. Estimating baseline kidney function in hospitalized patients with impaired kidney function. Clin J Am Soc Nephrol. 2012;7:712–9.CrossRef
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Yeh HC, Ting IW, Tsai CW, Wu JY, Kuo CC. Serum lactate level and mortality in metformin-associated lactic acidosis requiring renal replacement therapy: a systematic review of case reports and case series. BMC Nephrol. 2017;18:229.CrossRef
Metadata
Title
Metformin use and early lactate levels in critically ill patients according to chronic and acute renal impairment
Authors
Rene A. Posma
Adam Hulman
Reimar W. Thomsen
Bente Jespersen
Maarten W. Nijsten
Christian F. Christiansen
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2020
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-020-03300-y

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