Metformin has cardiorenal safety in diabetics with CKD but may not decrease MACE
Researchers have recently found that participants with chronic kidney disease from two cardiovascular outcomes trials support the cardiorenal safety of metformin but does not suggest a consistent benefit on major adverse cardiovascular events, all-cause mortality, or eGFR slope across this population, as published in the Journal of Diabetes, obesity and Metabolism.
Metformin, the most common first-line therapy for type 2 diabetes, is used frequently in patients with moderate and severe chronic kidney disease (CKD), despite concerns regarding lactic acidosis.
Therefore, Lindsay E Clegg and colleagues from the Clinical Pharmacology and Quantitative Pharmacology, Clinical Pharmacology and Safety Sciences, Gaithersburg, USA aimed to provide evidence on the cardiovascular and renal safety of metformin in CKD3-4.
The authors compared participants with eGFR 15-59 mL/min/1.73m2 in the Exenatide Study of Cardiovascular Event Lowering (EXSCEL) and the Saxagliptin and Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus (SAVOR)-TIMI 53 trials taking metformin, with those not exposed to metformin during these trials, using a propensity-matching approach. Adjusted Cox proportional hazards models were used to assess risk of major adverse cardiovascular events (MACE) and all-cause mortality (ACM). Metformin effect on eGFR slope was calculated using a mixed model-repeated measures (MMRM) analysis, and the number of lactic acidosis events was tabulated.
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