Abishek Tumma*,Tan KS
Background: Metformin has been a main stay medication in the treatment of type 2 diabetes mellitus. However, its use has been limited by its potential risk of metabolic acidosis in chronic kidney disease. Although this been anecdotally proposed, there have been no studies suggesting the effects of metformin in end stage renal failure, especially in the setting of peritoneal dialysis. We submit a case of metformin inadvertently used in end stage renal failure, without evidence of metabolic acidosis.
Case presentation: A 54 year old man with known type 2 diabetes mellitus presented late to our service with end stage renal failure. He had been on metformin at time of diagnosis of end stage renal failure. Although initially ceased on admission, metformin was inadvertently restarted on discharge from another hospital where he had been transferred for a tenchkoff catheter insertion. This issue was only realised 10 days later following an incidental medication review. He had already commenced peritoneal dialysis at this stage. He was asymptomatic and there was no evidence of metabolic acidosis. We hypothesise that Metformin use in end stage renal failure with dialysis may not be as harmful. To our knowledge, this is the first case report suggesting the use of metformin in such a setting.
Conclusion: Metformin has long been associated with the potential adverse effect of metabolic acidosis. However, our case report suggests further investigation into the potential use of metformin in end stage renal failure requiring dialysis, particularly those requiring peritoneal dialysis. In light of its overwhelming beneficial mortality effects, further studies would need to confirm the safety of such measures, including the need for a creation of an international registry.
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