Metformin Use in Diabetic Patients with Mild-to-Moderate Chronic Kidney Disease Is Not Associated with Lactic Acidosis

Using metformin in patients with type 2 diabetes is endorsed widely because of metformin's safety and cardiovascular benefits. However, the FDA restricts use of metformin in patients with essentially any level of chronic kidney disease (CKD) because of its renal clearance characteristics and its presumed predilection for causing lactic acidosis. These restrictions, in place since metformin's introduction 20 years ago, arose mostly from pharmacokinetic studies; however, subsequent clinical and postmarketing data and outcomes from unrestricted use outside the U.S. do not support this constraint.

In this systematic review, researchers identified 65 studies, mostly case series and observational postmarketing surveillance studies, that addressed …