Diabetic CKD: no link between metformin, acidosis after contrast CT

  • Jung J & al.
  • Clin Radiol
  • 12 Jun 2019

  • International Clinical Digest
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Takeaway

  • Metformin is not associated with an increased risk for contrast-induced nephropathy (CIN) or metabolic acidosis in patients with type 2 diabetes (T2D) and mild-moderate chronic kidney disease (CKD) undergoing CT scans.

Why this matters

  • Findings support 2018 recommendations from the American College of Radiology (ACR), which advises that it is not necessary to discontinue metformin before/after administration of iodinated contrast media in patients with estimated glomerular filtration rate (eGFR, in mL/minute/1.73 m2) ≥30 in the absence of acute kidney injury.
  • However, metformin prescribing information recommends stopping metformin at or before an iodinated contrast imaging procedure in patients with eGFR of 30-60.

Study design

  • 374 Korean patients with mild-moderate diabetic CKD (eGFR, 30-59) undergoing contrast CT (metformin, 42%; other antihypoglycemic agents [OHAs], 58%).
  • Funding: Institute of Health Sciences, Biomedical Research Institute Fund.

Key results

  • Patients receiving metformin vs other OHAs had higher median baseline eGFR (48.6 vs 44.3) and lower mean serum albumin (3.7±0.6 vs 3.5±0.7 g/dL).
  • Results showed similar rates of:
    • CIN (5.1% vs 10.1%; P=.085).
    • Metabolic acidosis (58% vs 65%; P=.195).
  • No relationship between CIN and postcontrast metabolic acidosis (P=.434).
  • Acidosis risk factors included malignancy (P=.022), low baseline serum albumin (P=.011), and low baseline serum total CO2 (P<.001>

Limitations

  • Retrospective design.