Attenuated Risk Association of End-Stage Kidney Disease with Metformin in Type 2 Diabetes with eGFR Categories 1-4
Type 2 diabetes (T2D)-associated end-stage kidney disease (ESKD) is a global burden, while the renoprotective effects of metformin remain controversial. In a population-based cohort (2002-2018) including 96,643 patients with T2D observed for 0.7 million person-years, we estimated the risk associatio...
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Published in | Pharmaceuticals (Basel, Switzerland) Vol. 15; no. 9; p. 1140 |
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Main Authors | , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Switzerland
MDPI AG
01.09.2022
MDPI |
Subjects | |
Online Access | Get full text |
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Summary: | Type 2 diabetes (T2D)-associated end-stage kidney disease (ESKD) is a global burden, while the renoprotective effects of metformin remain controversial. In a population-based cohort (2002-2018) including 96,643 patients with T2D observed for 0.7 million person-years, we estimated the risk association of metformin and its dose-relationship with ESKD in a propensity-score overlap-weighting (PS-OW) cohort by eGFR categories. Amongst 96,643, 83,881 (86.8%) had eGFR-G1/G2 (≥60 mL/min/1.73 m
), 8762 (9.1%) had eGFR-G3a (≥45-60 mL/min/1.73 m
), 3051 (3.2%) had eGFR-G3b (≥30-45 mL/min/1.73 m
), and 949 (1.0%) had eGFR-G4 (≥15-30 mL/min/1.73 m
). The respective proportions of metformin users in these eGFR categories were 95.1%, 81.9%, 53.8%, and 20.8%. In the PS-OW cohort with 88,771 new-metformin and 7872 other oral glucose-lowering-drugs (OGLDs) users, the respective incidence rates of ESKD were 2.8 versus 22.4/1000 person-years. Metformin use associated with reduced risk of ESKD (hazard ratio (HR) = 0.43 [95% CI: 0.35-0.52] in eGFR-G1/G2, 0.64 [0.52-0.79] in eGFR-G3a, 0.67 [0.56-0.80] in eGFR-G3b, and 0.63 [0.48-0.83] in eGFR-G4). Metformin use was associated with reduced or neutral risk of major adverse cardiovascular events (MACE) (7.2 versus 16.0/1000 person-years) and all-cause mortality (14.6 versus 65.1/1000 person-years). Time-weighted mean daily metformin dose was 1000 mg in eGFR-G1/G2, 850 mg in eGFR-G3a, 650 mg in eGFR-G3b, and 500 mg in eGFR-G4. In a subcohort of 14,766 patients observed for 0.1 million person-years, the respective incidence rates of lactic acidosis and HR in metformin users and non-users were 42.5 versus 226.4 events/100,000 person-years (
= 0.03) for eGFR-G1/G2 (HR = 0.57, 0.25-1.30) and 54.5 versus 300.6 events/100,000 person-years (
= 0.01) for eGFR-G3/G4 (HR = 0.49, 0.19-1.30). These real-world data underscore the major benefits and low risk of lactic acidosis with metformin use down to an eGFR of 30 mL/min/1.73 m
and possibly even 15 mL/min/1.73 m
, while reinforcing the importance of dose adjustment and frequent monitoring of eGFR. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 1424-8247 1424-8247 |
DOI: | 10.3390/ph15091140 |