Lactic acidosis due to metformin in type 2 diabetes mellitus and chronic kidney disease stage 3–5: is it significant?

  • Ravindra Attur PrabhuEmail author
  • Aswani Srinivas Mareddy
  • Shankar Prasad Nagaraju
  • Dharshan Rangaswamy
  • Vasudeva Guddattu
Nephrology - Original Paper



To study the incidence of lactic acidosis due to metformin in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) stage 3–5.


We estimated plasma lactate in patients of CKD stage 3 and worse who were continuing metformin on their own prior to stopping the drug.


Of 40 patients included, median duration of T2DM was 60 months (interquartile range IQR 24–120). The mean serum creatinine was 309.4 ± 159.1 µmol/L and mean eGFR was 27.82 ± 12.93 mL/min/1.73 m2 with 3 (7.5%), 16 (40%), 11 (27.5%) and 10 (25%) in CKD stages 3a, 3b, 4 and 5, respectively. They were receiving metformin for a median duration of 24 months (IQR 12.5–60), an average dose of 896 ± 350 mg per day. The median of plasma lactate was 1.36 mmol/L (IQR 1.11–1.75 mmol/L) with three (7.5%) having levels above normal, two (20%) in CKD stage 5 and one (9.1%) in stage 4.


Metformin can be safely used in CKD stage 3 and with regular measurement of plasma lactate in later stages.


Chronic kidney disease Lactic acidosis Metformin Type 2 diabetes mellitus 



This study was funded through a seed grant from Manipal Academy of Higher Education, India.

Author contribution

RAP: study concept and design, ASM: acquisition of data, SPN and DR: preparation of manuscript, VG: statistical analysis. All authors contributed to the preparation of the report and approved the final version. We have included a conflict of interest disclosure statement in the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Statement of ethics

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of NephrologyKasturba Medical College and Hospital Manipal, Manipal Academy Higher EducationUdupiIndia
  2. 2.Department of StatisticsPrasanna School of Public Health, MAHEUdupiIndia

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