Is Metformin Safe for Kidneys?

Metformin is considered safe for the kidneys in individuals with normal to moderately impaired kidney function. Healthcare providers should assess kidney function before initiating metformin and continue to monitor it during treatment for ongoing safety.

Mild to moderate chronic kidney disease (CKD)

Metformin is a widely prescribed medication for managing type 2 diabetes. Its safety concerning kidney function has been extensively studied. Current evidence indicates that metformin is safe for individuals with normal kidney function and those with mild to moderate chronic kidney disease (CKD). Specifically, patients with an estimated glomerular filtration rate (eGFR) of 45 mL/min/1.73 m² or higher can generally use metformin without significant risk, according to a retrospective observational cohort study.

For patients with severe CKD

In 2016, the U.S. Food and Drug Administration (FDA) updated its guidelines, stating that metformin is contraindicated only in patients with severe CKD, defined as an eGFR below 30 mL/min/1.73 m². For those with moderate CKD (eGFR between 30 and 59 mL/min/1.73 m²), metformin can be used safely with appropriate monitoring. ​

Rare cases of lactic acidosis

Metformin is primarily excreted by the kidneys. In cases of severe renal impairment, the drug can accumulate, potentially leading to a rare but serious condition known as lactic acidosis. However, a study has shown that the incidence of lactic acidosis in metformin users is low and comparable to that in the general diabetic population. ​

Participants with autosomal dominant polycystic kidney disease (ADPKD)

Recent research suggests that metformin may offer protective benefits for the kidneys. A 2021 prospective, randomized, controlled, double-blind clinical trial found that metformin was safe and well-tolerated in participants with autosomal dominant polycystic kidney disease (ADPKD), a condition that causes cysts to form in the kidneys. While more research is needed, these findings point to potential therapeutic roles for metformin in kidney disease management. ​

Where to buy metformin

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