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Dosing Recommendations of Lalau et al for Metformin in a Patient with Type 2 Diabetes and Stage 3 or 4 Chronic Kidney Disease (CKD)

Description

Metformin may accumulate in a patient with kidney disease, potentially leading to lactic acidosis. Lalau et al outlined certain precautions that can help to avoid this complication. The authors are from Amiens University Medical Center, Universite de Picardie Jules Verne, University of Ghent and the University of Antwerp.


Patient selection: diabetes type 2 and chronic kidney disease (Stages 3A, 3B, 4)

 

Recommendations:

(1) adjusting the daily dose for the stage of chronic kidney disease (CKD)

(2) monitoring plasma metformin concentrations

(3) monitoring serum lactate concentration

(4) discontinuing metformin if certain conditions are present

 

Stage of CKD

Possible Daily Dose

3A

1,500 mg

3B

1,000 mg

4

500 mg

 

Indications to discontinue metformin therapy:

(1) acute renal failure

(2) elevated plasma metformin concentration (> 5 mg/dL in study group)

(3) elevated serum lactate concentration (one time > 5 mmol/L OR 2 consecutive values > 2.5 mmol/L)


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