Background: Metformin is one of the principal treatments in type 2 diabetes mellitus (T2DM) because of his benefits in cardiovascular system, cancer incidence or diabetes prevention.
In cases of advanced chronic kidney disease (ACKD) or acute renal failure may lead to a severe type B lactic acidosis with high rates of mortality restricting its use in these patients and depriving them of these important beneficial effects.
Summary: A systematic review, compiling recent and more relevant papers: systematic reviews, observational studies, original research, pharmacokinetic and pharmacodynamic studies and expert opinions about the current state and safety of metformin in advanced CKD. The analysis has been structured about pharmacokinetic and pharmacodynamic data, potential benefits, mortality and rate of metformin-associated metabolic acidosis (MALA).
Key Messages: Several papers described interesting pharmacokinetic and pharmacodynamic data of metformin behavior in advanced CKD. The dose-dependent toxicity, among other modifiable factors, with a low rate of MALA has been a strong finding. There is enough evidence to believe that a daily dose of 500mg with some medical advices seems safety and appropriate. A pilot clinical trial is imperative