Metformin therapy in patients with chronic kidney disease

被引：61

作者：

Duong, J. K. ^{[1
,2
]}

Roberts, D. M. ^{[1
,3
]}

Furlong, T. J. ^{[3
]}

Kumar, S. S. ^{[1
,2
]}

Greenfield, J. R. ^{[4
,5
]}

Kirkpatrick, C. M. ^{[6
]}

Graham, G. G. ^{[1
,2
]}

Williams, K. M. ^{[1
,2
]}

Day, R. O. ^{[1
,2
]}

机构：

[1] St Vincents Hosp, Dept Clin Pharmacol & Toxicol, Sydney, NSW 2010, Australia

[2] Univ New S Wales, Sch Med Sci, Sydney, NSW, Australia

[3] St Vincents Hosp, Dept Nephrol, Sydney, NSW 2010, Australia

[4] St Vincents Hosp, Dept Endocrinol, Sydney, NSW 2010, Australia

[5] Garvan Inst Med Res, Diabet & Obes Res Program, Sydney, NSW, Australia

[6] Monash Univ, Ctr Med Use & Safety, Clayton, Vic 3800, Australia

来源：

DIABETES OBESITY & METABOLISM | 2012年 / 14卷 / 10期

关键词：

diabetic nephropathy; metformin; pharmacokinetics; pharmacology; type; 2; diabetes; PHARMACOKINETICS;

D O I：

10.1111/j.1463-1326.2012.01617.x

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Metformin therapy is limited in patients with chronic kidney disease (CKD) due to the potential risk of lactic acidosis. This open-label observational study investigated metformin and lactate concentrations in patients with CKD (n=22; creatinine clearances 15-40 ml/min) and in two dialysed patients. Patients were prescribed a range of metformin doses (250-2000 mg daily) and metformin concentrations were compared with data from healthy subjects (scaled to 1500 mg twice daily). A subset of patients (n=7) was controlled on low doses of metformin (250 or 500 mg daily). No correlation between metformin and lactate concentrations was observed. Three patients had high lactate concentrations (>2.7 mmol/l) and two had high metformin concentrations (3-5 mg/l), but none had any symptoms of lactic acidosis. Reducing metformin dosage and monitoring metformin concentrations will allow the safe use of metformin in CKD, provided that renal function is stable.

引用

页码：963 / 965

页数：3

共 12 条

[1] The relationship between metformin therapy and the fasting plasma lactate in type 2 diabetes: The Fremantle Diabetes Study [J].

Davis, TME ;

Jackson, D ;

Davis, WA ;

Bruce, DG ;

Chubb, P .

BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, 2001, 52 (02) :137-144

[2] Novel Assay of Metformin Levels in Patients With Type 2 Diabetes and Varying Levels of Renal Function Clinical recommendations [J].

Frid, Anders ;

Sterner, Gunnar N. ;

Londahl, Magnus ;

Wiklander, Clara ;

Cato, Anne ;

Vinge, Ellen ;

Andersson, Anders .

DIABETES CARE, 2010, 33 (06) :1291-1293

[3] Clinical Pharmacokinetics of Metformin [J].

Graham, Garry G. ;

Punt, Jeroen ;

Arora, Manit ;

Day, Richard O. ;

Doogue, Matthew P. ;

Duong, Janna K. ;

Furlong, Timothy J. ;

Greenfield, Jerry R. ;

Greenup, Louise C. ;

Kirkpatrick, Carl M. ;

Ray, John E. ;

Timmins, Peter ;

Williams, Kenneth M. .

CLINICAL PHARMACOKINETICS, 2011, 50 (02) :81-98

[4] Establishment of a Database of Metformin Plasma Concentrations and Erythrocyte Levels in Normal and Emergency Situations [J].

Lalau, Jean-Daniel ;

Lemaire-Hurtel, Anne-Sophie ;

Lacroix, Christian .

CLINICAL DRUG INVESTIGATION, 2011, 31 (06) :435-438

[5]

National Collaborating Centre for Chronic Conditions, 2008, TYP 2 DIAB NAT CLIN

[6] Metformin: The Safest Hypoglycaemic Agent in Chronic Kidney Disease? [J].

Nye, Helen J. ;

Herrington, William G. .

NEPHRON CLINICAL PRACTICE, 2011, 118 (04) :C380-C383

[7]

Rossi S, 2011, AUSTR MED HDB 2011

[8] Effect of genetic variation in the organic cation transporter 1, OCT1, on metformin pharmacokinetics [J].

Shu, Y. ;

Brown, C. ;

Castro, R. A. ;

Shi, R. J. ;

Lin, E. T. ;

Owen, R. P. ;

Sheardown, S. A. ;

Yue, L. ;

Burchard, E. G. ;

Brett, C. M. ;

Giacomini, K. M. .

CLINICAL PHARMACOLOGY & THERAPEUTICS, 2008, 83 (02) :273-280

[9] Steady-state pharmacokinetics of a novel extended-release metformin formulation [J].

Timmins, P ;

Donahue, S ;

Meeker, J ;

Marathe, P .

CLINICAL PHARMACOKINETICS, 2005, 44 (07) :721-729

[10]

TUCKER GT, 1981, BRIT J CLIN PHARMACO, V12, P235

← 1 2 →