Metformin Associated Lactic Acidosis in Acute Kidney Injury Patients: A Propensity Score Analysis

Abstract

Pattarapon Wongput36659* and Chinakorn Sujimogkol36660

Background: Typically, Metformin-Associated Lactic Acidosis (MALA) results in Acute Kidney Injury (AKI). It has been proposed to be treated with dialysis to remove metformin. Due to the wide range of doses used, there is little information about initiating Hemodialysis (HD) with AKI and Metformin at any given dose.

Objective: To determine the relationship between risk prediction for dialysis and metformin exposure concentrations affecting AKI in hospitalized patients by comparing them to a propensity score-matched group of patients.

Methods: All type 2 diabetes patients with wide anion gap metabolic acidosis, lactic acidosis or Acute Kidney Injury were reviewed. Patients were divided into two groups based on the amount of metformin they received. Propensity Score Matching (PSM) was chosen as the predictive model for estimating probability.

Results: From 101 patients with AKI who met the study's inclusion criteria. Following matching, 53 patients and 30 controls were identified from 83 subjects. According to the ATE=0.179 result, patients taking 2000 mg or more of metformin per day are 18% more likely to develop HD than those taking less than 2000 mg.

Conclusion: When higher Metformin intake is recognized, the likelihood of receiving HD treatment increases by 0.18 or, it is attributed to an 18% increased chance of receiving HD treatment compared to those taking less than 2000 mg. The greater the dose of metformin, especially for those taking more than 2000 mg, appears to be a predictor of the need for Renal Replacement Therapy.