ArticleJournal of nephrology2019
Sustained low-efficiency dialysis for metformin-associated lactic acidosis in patients with acute kidney injury.
Article in Journal of nephrology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 19 citations in OpenAlex.
- Metformin-associated lactic acidosis during flood-related healthcare disruption in southern Thailand, 2025: a case series.Tropical medicine and health · 2026Article
- Regional citrate anticoagulation ensures safe and effective kidney replacement therapy in metformin-associated lactic acidosis.Clinical kidney journal · 2025Article
- Efficacy of continuous venovenous hemodiafiltration in patients with metformin associated lactic acidosis and acute kidney injury.Scientific reports · 2025Article
- Mortality Rate and Its Contributing Factors in Post-Surgical and Medical Patients with AKI Underwent CRRT.Tanaffos · 2024Article
- Archetypal sustained low-efficiency daily diafiltration (SLEDD-f) for critically ill patients requiring kidney replacement therapy: towards an adequate therapy.Journal of nephrology · 2023Review
- Regional citrate anticoagulation (RCA) in critically ill patients undergoing renal replacement therapy (RRT): expert opinion from the SIAARTI-SIN joint commission.Journal of anesthesia, analgesia and critical care · 2023Review
- Metformin, chronic nephropathy and lactic acidosis: a multi-faceted issue for the nephrologist.Journal of nephrology · 2021Review
- Identifying patients with metformin associated lactic acidosis in the emergency department.International journal of clinical pharmacy · 2020Article
- Extracorporeal treatment of metforminassociated lactic acidosis in clinical practice: a retrospective cohort study.European journal of clinical pharmacology · 2020Article
- Metformin-Induced Lactic Acidosis: A Question of Time.Case reports in critical care · 2020Article
- A patient with metformin-associated lactic acidosis successfully treated with continuous renal replacement therapy: a case report.Journal of medical case reports · 2019Article
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Authors and funding
10 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe choice of the specific modality and treatment duration of renal replacement therapy (RRT) to adopt in metformin-associated lactic acidosis (MALA) is still debated. We aimed to verify if sustained low-efficiency dialysis (SLED) is a rational choice in patients with MALA and acute kidney injury (AKI).
methodsWe collected serial serum metformin measurements, clinical parameters, and outcome data in ten consecutive patients (mean age 77 years [range 58-88], 5 males) admitted to our renal intensive care unit for suspected MALA associated with AKI and hemodynamic instability. Patients underwent a 16-h SLED session performed with either conventional dialysis machines or machines for continuous RRT (CRRT). A 2-compartment open-infusion pharmacokinetic model with first-order elimination was fitted to each subject's serum concentration-time data to model post-SLED rebound and predict the need for further treatments.
resultsTwo patients died within 24 h after SLED start. Three patients needed one further dialysis session. Surviving patients (n = 8) were dialysis-free at discharge. Metformin levels were in the toxic range at baseline (median [range] 32.5 mg/l [13.6-75.6]) and decreased rapidly by the end of SLED (8.1 mg/l [4.5-15.8], p < 0.001 vs. baseline), without differences according to the dialysis machine used (p = 0.84). We observed a slight 4-h post-SLED rebound (9.7 mg/l [3.5-22.0]), which could be predicted by our pharmacokinetic model. Accordingly, we predicted that the majority of patients would need one additional dialysis session performed the following day to restore safe metformin levels.
conclusionsA 16-h SLED session, performed with either conventional dialysis machines or CRRT machines, allows effective metformin removal in patients with MALA and AKI. However, due to possible post-SLED rebound in serum metformin levels, one additional dialysis treatment is required the following day in the majority of patients.
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