Metformin Use Safe in Moderate-to-Severe Chronic Kidney Disease and Type 2 Diabetes

January 5, 2018. Three studies were conducted to establish a safe, effective metformin dose for patients with type 2 diabetes (T2D) and moderate (stages 3A/3B) to severe (stage 4) chronic kidney disease (CKD). First, a dose-finding study evaluated blood metformin concentrations over 1 week in response to dose increases. Appropriate daily dosages were found to be: 1,500 mg in CKD3A; 1,000 mg in CKD3B; and 500 mg in CKD4. Next, a treatment study monitored patient blood metformin, lactate, and A1C levels to validate the previously identified optimal metformin dosage for each CKD stage. After 4 months, metformin concentrations stayed within accepted safety limits, there was no hyperlactatemia (except in 1 patient with myocardial infarction), and A1C levels were unchanged. Finally, pharmacokinetic parameters following a single 500 mg metformin dose were assessed, with no significant differences identified between different CKD stages. These studies demonstrated that metformin treatment is safe and effective in patients with T2D and moderate-to-severe CKD as long as dosage is adjusted according to renal function. Find more details in the abstract.