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)



(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


1,500 mg


1,000 mg


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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