- Metformin can be used safely in patients with comorbid type 2 diabetes mellitus (T2DM) and stage 3 chronic kidney disease (CKD).
- Use can have survival and cardiovascular (CV) benefits but may not slow CKD progression.
Why this matters
- Metformin is often withheld over concerns for lactic acidosis.
- Study of metformin users (n=591) and nonusers (n=3447) enrolled in the TREAT trial.
- 508 metformin users (85%) were propensity-score-matched with nonusers (CKD stage 3a, 29.5% vs 25.2%; 3b, 42.7% vs 45.3%).
- CV composite endpoint: death, heart failure hospitalization, myocardial infarction, stroke, or myocardial ischemia.
- Kidney disease endpoint: end-stage renal disease (ESRD) or death.
- Funding: Amgen.
- Metformin was associated with lower incidence (per 100 patient years) of mortality (4.6 vs 8.5), CV death (2.8 vs 5.2), CV composite endpoint (8.6 vs 11.9), and kidney disease endpoint (8.0 vs 10.9).
- ESRD rate was marginally higher (4.0 vs 3.6).
- In multivariate analysis, metformin use was associated with reduced:
- All-cause mortality (HR, 0.49; P<.001>
- CV death (HR, 0.49; P<.001>
- CV composite endpoint (HR, 0.66; P=.002);
- Combined endpoint of ESRD or death (HR, 0.77; P=.037).
- Nonrandomized metformin use.