Metformin Use After Hospital-Acquired AKI in Patients With Type 2 Diabetes

Among hospitalized patients, development of acute kidney injury (AKI) is an independent risk factor for mortality, and patients with higher AKI severity face higher mortality rates. Patients with type 2 diabetes without other comorbidity are often treated with metformin as antiglycemic therapy. Results of previous studies have suggested a pleiotropic effect as well as lower cardiovascular mortality in patients treated with metformin.

There are few data available on the use of metformin in the inpatient setting. Huiwen Chen and Hsin-Hsiung Chang conducted a retrospective cohort study to determine whether metformin use after recovery from AKI is associated with lower mortality and higher degree of lactic acidosis. Results of the study were reported during a poster session at the American Society of Nephrology Kidney Week 2023 in a poster titled Association of Inpatient Metformin Use After Recovery From AKI With Lactic Acidosis and Mortality in Type 2 Diabetes Mellitus (DM).

The study utilized the Medical Information MART for Intensive Care IV data released by the Massachusetts Institute of Technology Laboratory for Computational Physiology. The database included intensive care unit data from a single tertiary care hospital from 2008 to 2019. The outcomes of interest were analyzed using propensity-score matching.

Thirty-seven of the 922 metformin users and 3747 of the 5175 non-metformin users had lactate level evaluation available. Of those with data on lactate level, median level was 1.4 in the metformin-users arm versus 1.4 in the non-metformin-users arm. There was no statistical difference in the degree of lactic acidosis between the two arms.

“Metformin therapy during hospitalization after AKI recovery in patients with type 2 diabetes mellitus is not associated with increased risk of lactic acidosis,” the authors said. “In addition, metformin use after recovery from AKI stage 2 and stage 3 is associated with lower 1-year mortality than metformin nonusers.”

Source: Chen H, Chang H-H. Association of inpatient metformin use after recovery from AKI with lactic acidosis and mortality in type 2 diabetes mellitus (DM). TH-PO062. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2023; November 2, 2023; Philadelphia, Pennsylvania.