Metformin therapy and kidney disease: a review of guidelines and proposals for metformin withdrawal around the world.

摘要: Objective We compared and contrasted guidelines on metformin treatment in patients with chronic kidney disease (CKD) around the world, aim of helping physicians to refine their analysis available evidence before deciding whether continue or withdraw this drug. Methods We performed a systematic research for contraindications in: (i) official documents from world's 20 most populated countries scientifically productive field diabetology (ii) publications referenced electronic databases 1990 onwards. Results We identified three international guidelines, 31 national proposals scientific literature. The criteria withdrawal were mainly qualitative countries; quantitative (with, all cases, suggested threshold withdrawing metformin); (iii) all, but one literature proposals, cases (n = 17) and/or adjustment dose as function renal status (n = 8). There was good degree consensus serum creatinine thresholds; whereas based estimated glomerular filtration rate thresholds varied 60 mL/minute/1.73 m2 up stage 5 CKD. Only has been tested prospective study. Conclusions In general, continuing stopping therapy CKD involve (whether rate) rather than (in stable patients) other drugs excreted by kidney. Copyright © 2013 John Wiley & Sons, Ltd.