METFORMIN FOR PREVENTING THE PROGRESSION OF CHRONIC KIDNEY DISEASE: A COCHRANE SYSTEMATIC REVIEW AND META-ANALYSIS
Miss Isabelle Kitty Stanley1, Ragada El-Damanawi2, Christine E Staatz3, Elaine M Pascoe4, Jonathan C Craig5,6, David W Johnson7,8,9, Carmel M Hawley7,8,9, Andrew J Mallett8,10,11, Elasma Milanzi12, Thomas F Hiemstra13, Andrea K Viecelli7,8
1The University Of Queensland, Brisbane, Australia, 2Sheffield Kidney Institute, Northern General Hospital, Sheffield , United Kingdom, 3The University of Queensland, School of Pharmacy, Brisbane, Australia, 4The University of Queensland, Centre for Health Services Research, Brisbane, Australia, 5Cochrane Kidney and Transplant, Westmead, Australia, 6College of Medicine and Public Health, Flinders University, Adelaide, Australia, 7Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia , 8Australasian Kidney Trials Network, The University of Queensland, Herston, Australia, 9Translational Research Institute, Brisbane, Australia, 10Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia, 11Department of Renal Medicine, Townsville Hospital & Health Service, Townsville, Australia, 12School of Population and Global Health, University of Melbourne, Melbourne, Australia, 13Cambridge Clinical Trials Unit, University of Cambridge, , United Kingdom
Aim: To evaluate the effects of metformin therapy on kidney function in patients with chronic kidney disease (CKD) and/or diabetes mellitus.
Background: Emerging evidence suggests that metformin targets several pathways that contribute to kidney damage and therefore may slow CKD progression.
Methods: We searched the Cochrane Kidney and Transplant Register of Studies up to 19 July 2023. We included randomised controlled trials (RCTs) of adult participants with CKD of any aetiology and/or diabetes mellitus, treated for a minimum of 12 months, and that reported kidney-related outcomes.
Results: Eleven RCTs with 8463 participants were eligible, this included four trials in participants with autosomal dominant polycystic kidney disease and seven trials in participants with diabetes. Metformin, compared to placebo, may slightly slow decline in estimated glomerular filtration rate (eGFR) (3 studies, 505 participants: mean difference [MD] 1.92 mL/min, 95% CI, 0.33 to 3.51). This evidence was of low certainty due to indirectness of the trial populations and sparse data. Compared to active comparators, there were very uncertain effects of metformin on change in eGFR, due to sparse data (1 study, 3914 participants: MD 1, 95% CI 2.83 to 0.83). Compared to placebo or active comparators, metformin had little or no effect on the incidence of serious adverse events (3 placebo-controlled studies, 576 participants: relative risk [RR] 1.15, 95% CI 0.76 to 1.72), (2 active-comparator studies, 5545 participants: RR 1.19, 95% CI 0.79 to 1.71).
Conclusions: The effects of metformin on kidney function are uncertain in patients with CKD, due to a lack of data in this population. Future research requires adequately powered RCTs comparing metformin to placebo or standard of care in those with CKD.
Biography:
A PhD student with the University of Queensland and pharmacist a the Gold Coast University Hospital.