Use of Metformin in cases of Chronic Kidney Disease

[BaliRob]

This post is intended for those members suffering with Chronic Kidney Disease (CKD) and is not a reflection on the use of Metformin/Glucophage in any other circumstances.

I have just had my CKD confirmed as Stage 3 eGFR (estimated glomerula filtration rate) from a maximum Stage 5 (dialysis).

There is much global argument on the use of Metformin ONCE CKD HAS BEEN CONFIRMED and my specialist has asked me, knowing the very large membership of this forum, to enquire of those of you that, until you were diagnosed with CKD, whether you were using Metformin and, if by Stage 3, great caution was being exercised by your doctors with possible 50% reduction in mg daily or even being taken off Metformin completely.

I will repeat that nobody is suggesting that Metformin causes CKD just that it may be of less use in cases such as mine or even detrimental.

I have supplied two titles for you to Google (or, subject to the moderators can email both as attachments to those of you that are allowed to contact me by private email):-

1) ADA (American Diabetes Association) "Use of Metformin in the Setting of Mild-to-Moderate Renal Insufficiency". Lipska, Bailey & Inzucchi.

2) "Diabetes Management Issues for Patients with Chronic Kidney Disease". Kerri L. Cavanaugh MD.

Your help and co-operation would be greatly apprecialed.

Thankyou - BaliRob

 

[WhitbyJet]

I was diagnosed with stage 3 CKD and my dose of Metformin was halved. However I very quickly developed lactic acidosis and nearly died..
Metformin was stopped immediately.

My kidney function has gone back up to stage 2 but I think that's the best I can hope for.

All the best to you

 

[BaliRob]

Thankyou WhitbyJet - this is the first time I have felt a pang of fear since being diagnosed - what replaced Metformin can I ask please?

 

[WhitbyJet]

Glicelazide and Avandia but that's been withdrawn now. Then a extreme low carb diet. Now I don't need any medication.
Don't be scared keep your stage 3 do all you can to stop it deteriorating it might even improve you never know.
Keep blood pressure and bg tightly controlled use fresh herbs and spices and eat as healthy as you can. Do exercise and deep breathing exercises this will help carry oxygen to your vital organs.
Do you have symptoms at all??

 

[CollieBoy]

I was diagnose CKD4 same time as D2 :cry:
Never put on met , Initially on insulin then Glic but nearly weaned off that. :clap:
eGFR generall floats around the CKD3/4 border now.
Still on raft of drugs to control BP but BP varies day-to-day between 90/50 & 140/80 :thumbdown:

 

[BaliRob]

Thankyou Whitby and Fergus - In answer to Whitby - yes I do have symptoms. Oedema legs, ankles and feet which is only controlled with Lasix. Also, during the past few weeks have been overcome with tiredness and lethargy which is not like me

 

[BaliRob]

Dear Fergus,

Are you permanently on insulin? Have you been told why your blood pressure is so wayward? The reason I ask is, after a lifetime of perfect BP 120/over, while in my doctor's consulting room this week, - on arrival mine read 140/80 and two hours later 130/70. My heart is supposed to be perfectly healthy so is this due to the condition of my kidneys? Have you been told something I don't know? By the way I was (always am) perfectly calm throughout so it was not 'doctor's white coat syndrome' and with whom I have a perfect relationship.

Rob

 

[CollieBoy]

Dear Fergus,

Are you permanently on insulin?
Rob

No, I was put on insulin at diagnosis tried to reduce it, weaned off that and on to gliclazide, got almost off that and only ned it in exceptional circumstances.

Have you been told why your blood pressure is so wayward? The reason I ask is, after a lifetime of perfect BP 120/over, while in my doctor's consulting room this week, - on arrival mine read 140/80 and two hours later 130/70. My heart is supposed to be perfectly healthy so is this due to the condition of my kidneys? Have you been told something I don't know? By the way I was (always am) perfectly calm throughout so it was not 'doctor's white coat syndrome' and with whom I have a perfect relationship.
Rob

Rob, All I can get from Nephrologist is that it's just a diabetic thing, but then she is one of those HCPs who has difficulty giving data to patients (she thought the new HbA1c values were to complicated for me to understand, and me with BSc(hons) and anatomy, physiology, biochemistry,microbiology&pharmacology to 2nd year degree :crazy: ) I do have white coat syndrome but get on great with my GP and his staff. :thumbup:

 

[BaliRob]

Thankyou Fergus.

Surely there others of you out there with CKD and have been or are still using Metformin? Please, if you have any contact with experts on the matter, please get in touch.

 

[catherinecherub]

Hi Rob,

I personally have no knowledge of kidney disease but would like to add something to lessen your traumatic discovery.

I saw my G,P, yesterday and asked him about Metformin and reduced kidney function. He said that he would discontinue Metformin for any patient that had a GFR of 60 or below as Metformin is primarily excreted via the kidneys and tends to accumulate in kidney disease. This means that there is a high possibility of lactic acidosis occurring in the patient and it can be life threatening. He also said that Metformin therapy is contra indicated in renal impairment.

I asked him about a substitute medication that would be safe. Her reckoned that if the HBA1c was an acceptable level and bearing in mind that Metformin does not make a great impact on lowering blood sugars then he would monitor the patient closely for a month to see what happened with the blood sugar levels. If levels started rising and medication was needed then he would opt for insulin as there is always the possibility of side effects with oral meds.

As you can appreciate my G.P. does not know you, has no access to your medical notes or history, the conversation was not specific to you but I hope it might help you. I admire him greatly and he is always willing to listen and has always given me good advice.

The only other thing I can suggest is that you ask to be referred to a Nephrologist.

Take care.

CC.

 

[BaliRob]

Dear Catherinecherub,

This was just the sort of reply I was hoping for and is a mirror image of my condition in principle.

My eGFR was 48 so you can see why I am concerned. As for finding a Nephrologist, that might be
a problem here and, as I have the best doctor in my life, would not want to offend him so tact and
diplomacy may be called for. But try to find one I will.

My doctor has arranged for me to see him one month from last tests this week but, as my Creatinine
levels have been quietly rising, I am not too optimistic.

I wish I knew what your doctor thought of was an "Acceptable HbA1C" in these particular cases - I am
not over 7% but would very much like to be in the 5% range.

This was a very helpful piece of advice - thankyou.

Rob