Metformin Might Have Unfavourable Outcomes in Patients with CKD

A recent study suggests that treatment with metformin was associated with an increased risk of major adverse cardiac and cerebrovascular events (MACCE) but lower all-cause mortality and end-stage renal disease (ESRD).

The study findings were published in the journal Kidney Research and Clinical Practice on November 29, 2021.

Although new classes of anti-diabetes drugs have shown significant benefits in preventing CVD development, metformin is still the first-line drug for DM management. However, the relationship between metformin use and clinical outcomes in CKD remains controversial. Moreover, there is a lack of consensus about the relationship between metformin use and clinical outcomes in patients with CKD. Therefore, Dr Hyoungnae Kim and his team conducted a study to evaluate the relationship between metformin use and the incidence of MACCE, all-cause mortality, and ESRD in CKD patients.

In this nationwide cohort study, the researchers included 97,713 diabetes patients with an estimated glomerular filtration rate of <60 mL/min/1.73 m2 from a large Korean health screening cohort. The major outcome assessed was the incidence of MACCE. The researchers also assessed all-cause mortality and incident end-stage renal disease (ESRD).

Key findings of the study:

• Upon analysis, the researchers found that the metformin users had a significantly higher risk of MACCE than non-users (hazard ratio [HR], 1.20).
• However, during follow up, they found that metformin users had a lower risk of all-cause mortality (HR, 0.78) and ESRD (HR, 0.44) when compared with non-users.
• They noted that the relationships between metformin use and clinical outcomes remained consistent in propensity score matching analyses and subgroup analyses of patients with adequate adherence to anti-diabetes medication.

The authors concluded, "Treatment with metformin was associated with an increased risk of MACCE in patients with diabetes and CKD. However, metformin users had a lower risk of all-cause mortality and ESRD during follow-up than non-users did. Therefore, metformin needs to be carefully used in patients with CKD."

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DOI: https://doi.org/10.23876/j.krcp.20.222