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In 2016, the U.S. FDA approved use of metformin in patients with moderately reduced renal function, because observational data suggested that risk for drug-induced lactic acidosis had been overstated. In this study from the U.S. Veterans Affairs system, researchers identified new users of metformin or sulfonylurea who continued taking the drugs after their estimated glomerular filtration rates (eGFRs) had declined to <60 mL/minute/1.73 m2 or after their serum creatinine had risen to ≥1.4 mg/dL (men) or ≥1.5 mg/dL (women). About 25,000 metformin users were propensity-matched to 25,000 sulfonylurea users, and hospitalizations for lactic acidosis were counted during the period after reduced renal function was first documented.
Lactic acidosis h…