Metformin use and mortality in patients with advanced chronic kidney disease: national, retrospective, observational, cohort study

Hung, Szu Chun; Chang, Yung Hsien; Liu, Jia Sin; Kuo, Ko‐Lin; Chen, Yu Hsin; Hsu, Chih Cheng; Tarng, Der Cherng

doi:10.1016/s2213-8587(15)00123-0

Cited by 128 publications

(146 citation statements)

References 33 publications

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“…It is the first-line drug for the treatment of type 2 diabetes, particularly, in overweight and obese patients with normal kidney function (American Diabetes, 2009;George, Joseph, 2014;Hung et al, 2015). In addition, recent research has proposed that metformin alone or in combination with insulin may be safe to treat gestational diabetes and does not increase the risk of metabolic acidosis (Huang, Castelino, Peterson, 2015; Kitwitee et al., 2015).…”

Section: Introductionmentioning

confidence: 99%

Effect of metformin on semen quality

Banihani

2016

Braz. J. Pharm. Sci.

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Various studies have linked metformin, a universally antidiabetic drug, with semen quality; however, such a direct link has not been established. This review systematically addresses and summarizes the effect of metformin on semen quality, particularly sperm function. We searched the MEDLINE electronic database for English articles and abstracts containing the key words 'metformin' and 'sperm', and relevant articles were reviewed. In summary, metformin appears to have improved and provided positive impact on sperm quality. This effect may be due to the ability of metformin to reduce oxidative stress and lipid peroxidation, enhance 5'-AMP activated protein kinase activity, and restore the normal levels of pituitary-gonadal hormones. However, further clinical research is still necessary to confirm such effect.Uniterms: Metformin/effects. Metformin/review. Metformin/semen quality. Sperm/study. Testosterone. Oxidative stress. 5'-AMP activated protein kinase. INTRODUCTIONMetformin, a biguanide-derivative antidiabetic drug, is the most widely used oral agent in humans (Brinkmann, Brixius, 2015;Chhetri, Thapa, Van Schepdael, 2014). It is the first-line drug for the treatment of type 2 diabetes, particularly, in overweight and obese patients with normal kidney function (American Diabetes, 2009;George, Joseph, 2014;Hung et al., 2015). In addition, recent research has proposed that metformin alone or in combination with insulin may be safe to treat gestational diabetes and does not increase the risk of metabolic acidosis (Huang, Castelino, Peterson, 2015; Kitwitee et al., 2015). Metformin's mechanism of action involves suppression of hepatic gluconeogenesis (Ferrannini, 2014; Foretz et al., 2010;Todd, Florez, 2014). One concern that has been raised relevant to metformin usage is that the consensus panel of diabetes felt that metformin should be considered for diabetes prevention even in non-diabetic individuals (i.e., pre-diabetic or obese individuals). This concern increases the use of this drug by these groups (American Diabetes, 2009;Hostalek, Gwilt, Hildemann, 2015;Manu et al., 2015;McGavock, Dart, Wicklow, 2015).Over the last decade, various experimental and clinical studies have linked metformin with sperm function, and thus with male factor infertility Ferreira et al., 2015); however, such direct link has not been established. In this review, we provide fresh and comprehensive understanding of the effect of metformin, as a universally used oral agent, on semen quality (i.e., sperm quantity and quality). To do this, we searched the MEDLINE electronic database for English-language articles and abstracts reported using the key words 'metformin' and 'sperm'. The references from selected articles were reviewed and used if relevant. Effect of metformin on sperm parameters Positive effectsTo date, the majority of studies linking metformin to sperm parameters are nonclinical. In his study on streptozotocin-induced diabetic rats, Attia, Helal, Alhaider (2009) made the seminal observation that metformin decreases the diabe...

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Section: Introductionmentioning

confidence: 99%

Effect of metformin on semen quality

Banihani

2016

Braz. J. Pharm. Sci.

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“…Indeed, in the aforementioned study by Hung et al, metformin was associated with increased mortality in those with advanced CKD approaching ESRD (KDIGO CKD stage 5) that was not explained by an increased risk of acidosis. 10 This is in contrast to observational studies in the wider population that have shown metformin monotherapy to be associated with lower mortality compared with other hypoglycaemic agents. 75,76 Interpreting this study should be done with caution, given the observational design and potential for confounding factors.…”

Section: A Lack Of Evidence For Metformin In Ckdmentioning

confidence: 91%

“…In a recent study by Hung et al, metformin use in 3,254 patients with advanced CKD approaching ESRD (creatinine >530 μmol/L) was not associated with a significantly greater risk of metabolic acidosis (adjusted HR 1.30, 95% CI 0.88 to 1.93). 10 Two large studies have analysed UK patient records from the Clinical Practice Research Datalink (CPRD) database. Richy et al examined the records of 77,601 patients treated with metformin for type 2 diabetes between 2007 and 2012.…”

Section: The Case Against Metformin Use In Ckdmentioning

confidence: 99%

“…In addition, a recent observational study has found metformin to be associated with greater mortality in patients approaching ESRD (CKD stage 5). 10 Recent reviews have focused on metformin and the risk of lactic acidosis in patients with CKD. 11,12 They concluded that the risk of this complication has been overemphasised in this group and that the current prescribing guidelines may be too restrictive.…”

Section: Introductionmentioning

confidence: 99%

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Metformin in advanced chronic kidney disease: are current guidelines overly restrictive?

et al. 2016

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Type 2 diabetes mellitus and chronic kidney disease (CKD) frequently co-exist and the increasing burden of both conditions is a global concern. Metformin is established as the first-line treatment for type 2 diabetes because it is associated with improved cardiovascular outcomes and a reduced risk of hypoglycaemia compared with other treatment options. Patients with CKD may benefit in particular because they are at high risk of both cardiovascular disease and hypoglycaemic episodes. However, the use of metformin is restricted in this population due to the concerns over lactic acidosis. Recent reviews have evaluated this risk and concluded that current guidelines for prescribing metformin in CKD may be too restrictive. This narrative review considers this evidence further, but also examines the strength of evidence that favours the use of metformin in CKD patients. Br J Diabetes 2016;16:168-175

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“…Los autores comentan que 153 (53 %) de los 334 estudios prospectivos permitieron la inclusión de pacientes con falla renal, lo que representó un seguimiento de 37.360 pacientes -años de uso de metformina. Uno de los estudios incluidos cuestionó las contraindicaciones estándar, al analizar 393 pacientes con, al menos, una contraindicación para su administración y no encontrar ningún caso de acidosis láctica en cuatro años de seguimiento 47 .…”

Section: Metformina Y La Restricción De La Función Renalunclassified

Metformina en enfermedad renal diabética: estado actual

Arocha-Rodulfo¹,

Maini²

2017

Rev. Colomb. Nefrol.

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El tratamiento actual dirigido a retardar la progresión de la enfermedad renal diabética, incluye un control intensivo de la glucemia con control óptimo de la hipertensión arterial, bloqueo del sistema renina-angiotensina-aldosterona junto a otras intervenciones multifactoriales. Sin embargo, la protección renal, a pesar de éstas medidas, no se alcanza en su totalidad, habiendo escasos estudios donde se analice el efecto nefroprotector de las drogas antihiperglucemiantes mas allá de su efecto hipoglucemiante.Este artículo analiza la información existente sobre el estatus actual de la metformina en la enfermedad renal diabética.

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Metformin use and mortality in patients with advanced chronic kidney disease: national, retrospective, observational, cohort study

Cited by 128 publications

References 33 publications

Effect of metformin on semen quality

Effect of metformin on semen quality

Metformin in advanced chronic kidney disease: are current guidelines overly restrictive?

Metformina en enfermedad renal diabética: estado actual

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