Shouldn’t Stage 4 And 5 Chronic Kidney Disease Patients Use Metformin?

Yıl 2023, Cilt: 18 Sayı: 2, 126 - 132, 12.07.2023

Muhammed Çiftçioğlu

https://doi.org/10.17517/ksutfd.1181458

Öz

Metformin is the first place anti-diabetic agent recommended with life style changes in many guidelines for the treatment of patients with type 2 diabetes
mellitus (DM). The mechanism of effect of the drug is to increase insulin sensitivity in peripheral tissue and reduce glucose secretion from the liver. Metformin
is a low cost, effective and safe drug. Although its frequent side effects are gastrointestinal side effects and the most feared side effect is lactic acidosis.
Due to this side effect, its use is limited in many guidelines in patients with chronic kidney disease (CKD). In this article, we examined the use of metformin
in all stages of CKD. We investigated the incidence of metformin-associated lactic acidosis (MALA). Shouldn’t stage 4 and 5 chronic kidney disease patients
use metformin? We sought an answer to question. As a result, we decided that side effects like MALA are extremely rare. We observed that these side effects
occur mostly in the presence of diseases in which tissue perfusion is impaired such as infections, serious cardiovascular events, and hypotension. Therefore
we concluded that the use of metformin may contraindicated in cases where the clinical condition of the patient is unstable rather than side effects such as
MALA and especially in stage 5 patients due to the increased risk of accumulation of the drug.

Anahtar Kelimeler

Metformin, Chronic kidney disease, Metformin-associated lactic acidosis

Evre 4 ve 5 Kronik Böbrek Hastaları Metformin Kullanmamalı mı?

Öz

Metformin tip 2 diyabetes mellitus (DM) tanılı hastaların tedavisi için birçok kılavuzda yaşam tarzı değişikliği ile birlikte ilk sırada önerilen anti diyabetik
ajandır. İlacın etki mekanizması periferik dokuda insülin duyarlılığını arttırması ve karaciğerden glukoz salınımını azaltmasıdır. Metformin düşük maliyetli,
etkin ve güvenilir bir ilaçtır. Sık yan etkisi gastrointestinal yan etkiler olması yanında en korkulan yan etkisi laktik asidozdur. Bu yan etkisi nedeniyle
kronik böbrek hastalığı (KBH) tanılı hastalarda birçok klavuzda kullanımı sınırlandırılmıştır. Biz bu yazıda KBH’nin her evresinde metformin kullanımını
inceledik. Metfomin ilişkili laktik asidoz (MALA) gelişim sıklığını araştırdık. Evre 4 ve evre 5 KBH hastaları metformin kullanmamalı mı? Sorusuna cevap
aradık. Sonuç olarak MALA gibi yan etkilerin son derece nadir olduğuna karar verdik. Bu yan etkilerin daha çok enfeksiyon, ciddi kardiyovasküler olay,
hipotansiyon gibi doku perfüzyonunun bozulduğu hastalıklar varlığında ortaya çıktığını gözlemledik. Dolayısıyla metformin kullanımının MALA gibi yan
etkilerden ziyade hastanın klinik durumunun stabil olmadığı durumlarda ve ilacın artmış birikim riski nedeniyle özellikle evre 5 hastalarda kontrendike
olabileceği kanaatine vardık.vre 4 ve evre 5 KBY’li hastalarda çok da korkmadan kar zarar ilişkisi göz önünde bulundurularak kullanılması gerekliliği kanaatine vardık.

Anahtar Kelimeler

Metformin, Kronik böbrek hastalığı, Metformin ilişkili laktik asidoz

Kaynakça

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