Dr Eimer McMullan1, Dr Shiobhan Burke1, A/Prof. Hemant Kulkarni1,2,3
1Royal Perth Hospital, Perth, Australia, 2Armadale Health Services, Mount Nasura, Australia, 3University of Western Australia, Crawley, Australia
Biography:
Dr Eimer McMullan is a Registrar at Renal Unit at Royal Perth Hospital, who completed her MBBS from Ireland. She has keen interest in exploring the data.
Background:
Off label use of Metformin in advanced CKD is common despite warnings against its use due to its association with lactic acidosis.
Aims:
To explore the safety of Metformin, use in patients with Stage IV and V CKD – An Audit about Safety in real-life clinical practice.
Methods:
We assessed the use of Metformin in advanced CKD within Renal Services at East Metro Health Services in patients who attended the services between April 2023 to April 2025 with a history of metformin use. The indication, dose, length of treatment during Stage 4 and Stage 5 CKD, and any recorded adverse events in Electronic or Paper based Medical Records were analysed in a retrospective study.
Results:
86 eligible subjects were recorded. All patients received treatment for Type 2 diabetes. Median metformin dose was 500mg XR OD in CKD V. 35 of the 86 patients were not on Metformin at the time at entry with most not needing the drug.
Metformin was tolerated by 77 of 86 patients on long term basis. 2 patients had documented Metformin induced Lactic Acidosis (MALA) in the records. In 2/2 patients MALA was related to acute illness (UTI and Enterovirus) and they recovered without any sequelae. Both patients were subsequently restarted on metformin without further complications.
8 ADRs lead to long term cessation of metformin including 2 ceased due to concerns for neurological sequalae.
Results:
Incidence of MALA in Stage 5 CKD is marginally elevated than general population. MALA is rare and can be managed with no sequelae. Metformin can be beneficially used in low doses with monitoring. Larger studies are needed to confirm our findings.