Risk of acute kidney injury and survival in patients treated with Metformin: an observational cohort study
Abstract Background Whether metformin precipitates lactic acidosis in patients with chronic kidney disease (CKD) remains under debate. We examined whether metformin use was associated with an increased risk of acute kidney injury (AKI) as a proxy for lactic acidosis and whether survival among those...
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doaj-82e6120d7ce74724820ef0a5563b18b52020-11-24T20:59:43ZengBMCBMC Nephrology1471-23692017-05-011811810.1186/s12882-017-0579-5Risk of acute kidney injury and survival in patients treated with Metformin: an observational cohort studySamira Bell0Bassam Farran1Stuart McGurnaghan2Rory J. McCrimmon3Graham P Leese4John R Petrie5Paul McKeigue6Naveed Sattar7Sarah Wild8John McKnight9Robert Lindsay10Helen M. Colhoun11Helen Looker12Renal Unit, Ninewells HospitalInstitute of Genetics and Molecular Medicine University of EdinburghInstitute of Genetics and Molecular Medicine University of EdinburghDivision of Molecular & Clinical Medicine, School of Medicine, University of DundeeDepartment of Medicine, University of DundeeInstitute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of GlasgowCentre for Population Health Sciences, University of Edinburgh Medical SchoolInstitute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of GlasgowCentre for Population Health Sciences, University of Edinburgh Medical SchoolDepartment of Medicine, Western General HospitalInstitute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of GlasgowInstitute of Genetics and Molecular Medicine University of EdinburghDivision of Population Health Sciences, School of Medicine, University of DundeeAbstract Background Whether metformin precipitates lactic acidosis in patients with chronic kidney disease (CKD) remains under debate. We examined whether metformin use was associated with an increased risk of acute kidney injury (AKI) as a proxy for lactic acidosis and whether survival among those with AKI varied by metformin exposure. Methods All individuals with type 2 diabetes and available prescribing data between 2004 and 2013 in Tayside, Scotland were included. The electronic health record for diabetes which includes issued prescriptions was linked to laboratory biochemistry, hospital admission, death register and Scottish Renal Registry data. AKI events were defined using the Kidney Disease Improving Global Outcomes criteria with a rise in serum creatinine of at least 26.5 μmol/l or a rise of greater than 150% from baseline for all hospital admissions. Cox Regression Analyses were used to examine whether person-time periods in which current metformin exposure occurred were associated with an increased rate of first AKI compared to unexposed periods. Cox regression was also used to compare 28 day survival rates following first AKI events in those exposed to metformin versus those not exposed. Results Twenty-five thousand one-hundred fourty-eight patients were included with a total person-time of 126,904 person years. 4944 (19.7%) people had at least one episode of AKI during the study period. There were 32.4 cases of first AKI/1000pyrs in current metformin exposed person-time periods compared to 44.9 cases/1000pyrs in unexposed periods. After adjustment for age, sex, diabetes duration, calendar time, number of diabetes drugs and baseline renal function, current metformin use was not associated with AKI incidence, HR 0.94 (95% CI 0.87, 1.02, p = 0.15). Among those with incident AKI, being on metformin at admission was associated with a higher rate of survival at 28 days (HR 0.81, 95% CI 0.69, 0.94, p = 0.006) even after adjustment for age, sex, pre-admission eGFR, HbA1c and diabetes duration. Conclusions Contrary to common perceptions, we found no evidence that metformin increases incidence of AKI and was associated with higher 28 day survival following incident AKI.http://link.springer.com/article/10.1186/s12882-017-0579-5Acute kidney injuryDiabetesEpidemiologyMetforminSurvival |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Samira Bell Bassam Farran Stuart McGurnaghan Rory J. McCrimmon Graham P Leese John R Petrie Paul McKeigue Naveed Sattar Sarah Wild John McKnight Robert Lindsay Helen M. Colhoun Helen Looker |
spellingShingle |
Samira Bell Bassam Farran Stuart McGurnaghan Rory J. McCrimmon Graham P Leese John R Petrie Paul McKeigue Naveed Sattar Sarah Wild John McKnight Robert Lindsay Helen M. Colhoun Helen Looker Risk of acute kidney injury and survival in patients treated with Metformin: an observational cohort study BMC Nephrology Acute kidney injury Diabetes Epidemiology Metformin Survival |
author_facet |
Samira Bell Bassam Farran Stuart McGurnaghan Rory J. McCrimmon Graham P Leese John R Petrie Paul McKeigue Naveed Sattar Sarah Wild John McKnight Robert Lindsay Helen M. Colhoun Helen Looker |
author_sort |
Samira Bell |
title |
Risk of acute kidney injury and survival in patients treated with Metformin: an observational cohort study |
title_short |
Risk of acute kidney injury and survival in patients treated with Metformin: an observational cohort study |
title_full |
Risk of acute kidney injury and survival in patients treated with Metformin: an observational cohort study |
title_fullStr |
Risk of acute kidney injury and survival in patients treated with Metformin: an observational cohort study |
title_full_unstemmed |
Risk of acute kidney injury and survival in patients treated with Metformin: an observational cohort study |
title_sort |
risk of acute kidney injury and survival in patients treated with metformin: an observational cohort study |
publisher |
BMC |
series |
BMC Nephrology |
issn |
1471-2369 |
publishDate |
2017-05-01 |
description |
Abstract Background Whether metformin precipitates lactic acidosis in patients with chronic kidney disease (CKD) remains under debate. We examined whether metformin use was associated with an increased risk of acute kidney injury (AKI) as a proxy for lactic acidosis and whether survival among those with AKI varied by metformin exposure. Methods All individuals with type 2 diabetes and available prescribing data between 2004 and 2013 in Tayside, Scotland were included. The electronic health record for diabetes which includes issued prescriptions was linked to laboratory biochemistry, hospital admission, death register and Scottish Renal Registry data. AKI events were defined using the Kidney Disease Improving Global Outcomes criteria with a rise in serum creatinine of at least 26.5 μmol/l or a rise of greater than 150% from baseline for all hospital admissions. Cox Regression Analyses were used to examine whether person-time periods in which current metformin exposure occurred were associated with an increased rate of first AKI compared to unexposed periods. Cox regression was also used to compare 28 day survival rates following first AKI events in those exposed to metformin versus those not exposed. Results Twenty-five thousand one-hundred fourty-eight patients were included with a total person-time of 126,904 person years. 4944 (19.7%) people had at least one episode of AKI during the study period. There were 32.4 cases of first AKI/1000pyrs in current metformin exposed person-time periods compared to 44.9 cases/1000pyrs in unexposed periods. After adjustment for age, sex, diabetes duration, calendar time, number of diabetes drugs and baseline renal function, current metformin use was not associated with AKI incidence, HR 0.94 (95% CI 0.87, 1.02, p = 0.15). Among those with incident AKI, being on metformin at admission was associated with a higher rate of survival at 28 days (HR 0.81, 95% CI 0.69, 0.94, p = 0.006) even after adjustment for age, sex, pre-admission eGFR, HbA1c and diabetes duration. Conclusions Contrary to common perceptions, we found no evidence that metformin increases incidence of AKI and was associated with higher 28 day survival following incident AKI. |
topic |
Acute kidney injury Diabetes Epidemiology Metformin Survival |
url |
http://link.springer.com/article/10.1186/s12882-017-0579-5 |
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