scholarly journals Metformin-Associated Acute Kidney Injury and Lactic Acidosis

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
David Arroyo ◽  
Rosa Melero ◽  
Nayara Panizo ◽  
Marian Goicoechea ◽  
Patrocinio Rodríguez-Benítez ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Lactic Acidosis ◽  
Renal Dysfunction ◽  
Rare Complication ◽  
Kidney Injury ◽  
Diabetic Patients ◽  
Related Factor ◽  
Volume Depletion ◽  
Oral Antidiabetic Agent

Objectives. Metformin is the preferred oral antidiabetic agent for type 2 diabetes. Lactic acidosis is described as a rare complication, usually during an acute kidney injury (AKI).Material and Methods. We conducted a prospective observational study of metformin-associated AKI cases during four years. 29 cases were identified. Previous renal function, clinical data, and outcomes were recorded.Results. An episode of acute gastroenteritis precipitated the event in 26 cases. Three developed a septic shock. Three patients died, the only related factor being liver dysfunction. More severe metabolic acidosis hyperkalemia and anemia were associated with higher probabilities of RRT requirement. We could not find any relationship between previous renal dysfunction and the outcome of the AKI.Conclusions. AKI associated to an episode of volume depletion due to gastrointestinal losses is a serious complication in type 2 diabetic patients on metformin. Previous renal dysfunction (mild-to-moderate CKD) has no influence on the severity or outcome.

scholarly journals Aquaporin 11 variant associates with kidney disease in type 2 diabetic patients

2016 ◽  
Vol 310 (5) ◽  
pp. F416-F425 ◽  
Author(s):  
David P. Choma ◽  
Roberto Vanacore ◽  
Helen Naylor ◽  
Ian A. Zimmerman ◽  
Andrei Pavlichenko ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Genetic Factor ◽  
Kidney Injury ◽  
Independent Study ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Baseline Serum ◽  
Type 2 Diabetic

Kidney disease, a common complication of diabetes, associates with poor prognosis. Our previous animal model studies linked aquaporin (AQP)11 to acute kidney injury, hyperglycemia-induced renal impairment, and kidney disease in diabetes. Here, we report the AQP11 rs2276415 variant as a genetic factor placing type 2 diabetic patients at greater risk for the development of kidney disease. We performed two independent retrospective case-control studies in 1,075 diabetic and 1,619 nondiabetic individuals who were identified in the Synthetic Derivative Database with DNA samples in the BioVU DNA repository at Vanderbilt University (Nashville, TN). A χ2-test and multivariable logistic regression analysis with adjustments for age, sex, baseline serum creatinine, and underlying comorbid disease covariates showed a significant association between rs2276415 and the prevalence of any event of acute kidney injury and chronic kidney disease (CKD) in diabetic patients but not in patients without diabetes. This result was replicated in the second independent study. Diabetic CKD patients over 55 yrs old with the minor AQP11 allele had a significantly faster progression of estimated glomerular filtration rate decline than patients with the wild-type genotype. Three-dimensional structural analysis suggested a functional impairment of AQP11 with rs2276415, which could place diabetic patients at a higher risk for kidney disease. These studies identified rs2276415 as a candidate genetic factor predisposing patients with type 2 diabetes to CKD.

scholarly journals Metformin induced acute kidney injury; a systematic review

2020 ◽  
Vol 10 (2) ◽  
pp. e13-e13
Author(s):  
Mahnaz Momenzadeh ◽  
Bhaskar VKS Lakkakula
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Control Group ◽  
Diabetic Patients ◽  
Manual Search ◽  
Contrast Exposure ◽  
Present Systematic Review

Introduction: Metformin is the best proven first-line treatment for type 2 diabetes (T2DM), based on both national and international guidelines. The present systematic review is aimed to examine the acute kidney injury (AKI) risk associated with metformin. Methods: A systematic literature search was performed in MEDLINE, PubMed and google scholar, to retrieve the literature related to the metformin use. A bibliographic management software (Endnote X9) was used for managing the literature. The following keywords were used: "Acute renal injury OR ARI", "Acute kidney injury OR AKI"," Metformin", " Type 2 diabetes mellitus OR T2DM", "Diabetic patients", "Renal function", "CKD". Results: About 28 relevant articles were found during the electronic and manual search. Finally, a total of four articles that fulfill the inclusion criteria were used for this systematic literature review. There is no evidence to suggest that metformin increases the incidence of AKI and is associated with an increased survival of 28 days following AKI event. Further, there was no difference in the incidence of AKI in patients who continued metformin after arterial contrast exposure compared with the control group. Conclusion: In summary, there is no evidence that metformin increases the incidence of AKI. More clinical trials are needed in this area, to investigate more evidence so that we can better understand the outcome.

Proposal for the administration of metformin in patients with chronic kidney disease

2012 ◽  
Vol 153 (39) ◽  
pp. 1527-1535 ◽  
Author(s):  
Zoltán Balogh ◽  
János Mátyus
Keyword(s):  
Lactic Acidosis ◽  
Chronic Renal Disease ◽  
Antidiabetic Agent ◽  
First Line ◽  
Oral Antidiabetic Agent ◽  
Oral Antidiabetic ◽  
Cardiovascular Morbidity And Mortality ◽  
Glomerular Filtrate ◽  
Life Threatening

Metformin is the first-line, widely used oral antidiabetic agent for the management of type 2 diabetes. There is increasing evidence that metformin use results in a reduction in cardiovascular morbidity and mortality, and might have anticancer activity. An extremely rare, but potentially life-threatening adverse effect of metformin is lactic acidosis, therefore, its use is traditionally contraindicated if the glomerular filtrate rate is below 60 mL/min. However, lactic acidosis is always associated with acute events, such as hypovolemia, acute cardiorespiratory illness, severe sepsis and acute renal or hepatic failure. Furthermore, administration of insulins and conventional antihyperglycemic agents increases the risk of severe hypoglycemic events when renal function is reduced. Therefore, the magnitude of the benefit of metformin use would outweigh potential risk of lactic acidosis in moderate chronic renal disease. After reviewing the literature, the authors give a proposal for the administration of metformin, according to the calculated glomerular filtrate rate. Orv.Hetil., 2012, 153, 1527–1535.

scholarly journals Predictive value of stress hyperglycemia ratio for the occurrence of acute kidney injury in acute myocardial infarction patients with diabetes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Side Gao ◽  
Qingbo Liu ◽  
Hui Chen ◽  
Mengyue Yu ◽  
Hongwei Li
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Kidney Injury ◽  
Cardiogenic Shock ◽  
Predictive Value ◽  
Kidney Injury ◽  
Left Ventricular Ejection ◽  
Diabetic Patients ◽  
Stress Hyperglycemia ◽  
Patients With Diabetes

Abstract Background Acute hyperglycemia has been recognized as a robust predictor for occurrence of acute kidney injury (AKI) in nondiabetic patients with acute myocardial infarction (AMI), however, its discriminatory ability for AKI is unclear in diabetic patients after an AMI. Here, we investigated whether stress hyperglycemia ratio (SHR), a novel index with the combined evaluation of acute and chronic glycemic levels, may have a better predictive value of AKI as compared with admission glycemia alone in diabetic patients following AMI. Methods SHR was calculated with admission blood glucose (ABG) divided by the glycated hemoglobin-derived estimated average glucose. A total of 1215 diabetic patients with AMI were enrolled and divided according to SHR tertiles. Baseline characteristics and outcomes were compared. The primary endpoint was AKI and secondary endpoints included all-cause death and cardiogenic shock during hospitalization. The logistic regression analysis was performed to identify potential risk factors. Accuracy was defined with area under the curve (AUC) by a receiver-operating characteristic (ROC) curve analysis. Results In AMI patients with diabetes, the incidence of AKI (4.4%, 7.8%, 13.0%; p < 0.001), all-cause death (2.7%, 3.6%, 6.4%; p = 0.027) and cardiogenic shock (4.9%, 7.6%, 11.6%; p = 0.002) all increased with the rising tertile levels of SHR. After multivariate adjustment, elevated SHR was significantly associated with an increased risk of AKI (odds ratio 3.18, 95% confidence interval: 1.99–5.09, p < 0.001) while ABG was no longer a risk factor of AKI. The SHR was also strongly related to the AKI risk in subgroups of patients. At ROC analysis, SHR accurately predicted AKI in overall (AUC 0.64) and a risk model consisted of SHR, left ventricular ejection fraction, N-terminal B-type natriuretic peptide, and estimated glomerular filtration rate (eGFR) yielded a superior predictive value (AUC 0.83) for AKI. Conclusion The novel index SHR is a better predictor of AKI and in-hospital mortality and morbidity than admission glycemia in AMI patients with diabetes.

scholarly journals Incidence and risk predictors of acute kidney injury among HIV-positive patients presenting with sepsis in a low resource setting

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Davis Kimweri ◽  
Julian Ategeka ◽  
Faustine Ceasor ◽  
Winnie Muyindike ◽  
Edwin Nuwagira ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Significant Risk ◽  
Kidney Injury ◽  
Significant Risk Factor ◽  
Hiv Positive ◽  
Volume Depletion ◽  
Adjusted Risk ◽  
Adjusted Analysis ◽  
Resource Setting ◽  
Risk Predictors

Abstract Background Acute kidney injury (AKI) is a frequently encountered clinical condition in critically ill patients and is associated with increased morbidity and mortality. In our resource-limited setting (RLS), the most common cause of AKI is sepsis and volume depletion. Sepsis alone, accounts for up to 62 % of the AKI cases in HIV-positive patients. Objective The major goal of this study was to determine the incidence and risk predictors of AKI among HIV-infected patients admitted with sepsis at a tertiary hospital in Uganda. Methods In a prospective cohort study, we enrolled adult patients presenting with sepsis at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda between March and July 2020. Sepsis was determined using the qSOFA criteria. Patients presenting with CKD or AKI were excluded. Sociodemographic characteristics, physical examination findings, and baseline laboratory values were recorded in a data collection tool. The serum creatinine and urea were done at admission (0-hour) and at the 48-hour mark to determine the presence of AKI. We performed crude and multivariable binomial regression to establish the factors that predicted developing AKI in the first 48 h of admission. Variables with a p < 0.01 in the adjusted analysis were considered as significant predictors of AKI. Results Out of 384 patients screened, 73 (19 %) met our inclusion criteria. Their median age was 38 (IQR 29–46) years and 44 (60.3 %) were male. The median CD4 T-cell count was 67 (IQR 35–200) cells, median MUAC was 23 (IQR 21–27) cm and 54 (74.0 %) participants were on a regimen containing Tenofovir Disoproxil Fumarate (TDF). The incidence of AKI in 48 h was 19.2 % and in the adjusted analysis, thrombocytopenia (Platelet count < 150) (adjusted risk ratio 8.21: 95 % CI: 2.0–33.8, p = 0.004) was an independent predictor of AKI. Conclusions There is a high incidence of AKI among HIV-positive patients admitted with sepsis in Uganda. Thrombocytopenia at admission may be a significant risk factor for developing AKI. The association of thrombocytopenia in sepsis and AKI needs to be investigated.

Sustained low-efficiency dialysis for metformin-associated lactic acidosis in patients with acute kidney injury

2018 ◽  
Vol 32 (2) ◽  
pp. 297-306 ◽  
Author(s):  
Paolo Greco ◽  
Giuseppe Regolisti ◽  
Umberto Maggiore ◽  
Elena Ferioli ◽  
Filippo Fani ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Lactic Acidosis ◽  
Kidney Injury ◽  
Low Efficiency
Sign in / Sign up

Export Citation Format

Share Document