Diabetes mellitus is the leading cause of chronic kidney disease (CKD) globally. For decades, a first line therapy against diabetes has been metformin. Metformin has the advantage of being an effective anti-hyperglycemic agent that also facilitates weight loss; however, it is considered unsafe in patients with renal insufficiency because of fears about lactic acid accumulation. Fears about metformin use in patients with CKD arise from the theoretical ability of the drug to generate large amounts of lactic acid.
Metformin inhibits the respiratory chain within the mitochondria, forcing cells in the body to perform anaerobic metabolism (metabolism that does not use oxygen). A large by-product of anaerobic metabolism is lactic acid, which acidifies the blood and, if present in a high concentration, can cause multi organ dysfunction. Because the kidneys excrete metformin, any degree of…
