1. Metformin-Associated Lactic Acidosis Undergoing Renal Replacement Therapy in Intensive Care Units: A Five-Million Population-Based Study in the North-West of Italy
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Andrea Campo, Emanuele Stramignoni, Elisabetta Roscini, Paola Inguaggiato, Patrizia Vio, Paola David, Massimo Manes, Alessandro Amore, Filippo Mariano, Vincenzo Todini, Cesare Guarena, Giovanni Calabrese, Oliviero Filiberti, Vincenzo Cantaluppi, Luciano Comune, Valentina Consiglio, Silvia Berutti, Ernesto Turello, Paola Carpani, Marco Pozzato, Maurizio Gherzi, Andrea Serra, Guido Martina, Mauro Berto, Antonio Marciello, Angela Marino, and Roberto Boero
- Subjects
Male ,medicine.medical_specialty ,Survival ,Critical Care ,Epidemiology ,medicine.medical_treatment ,urologic and male genital diseases ,03 medical and health sciences ,0302 clinical medicine ,Oliguria ,Intensive care ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Renal replacement therapy ,Survival rate ,Dialysis ,Aged ,Retrospective Studies ,Lactic acidosis ,business.industry ,Acute kidney injury ,Intensive care units ,Metformin ,Hematology ,Nephrology ,Incidence (epidemiology) ,030208 emergency & critical care medicine ,General Medicine ,medicine.disease ,female genital diseases and pregnancy complications ,Surgery ,Renal Replacement Therapy ,Intensive Care Units ,Italy ,Acidosis, Lactic ,Female ,medicine.symptom ,business ,Complication - Abstract
Background: Metformin-associated lactic acidosis (MALA) is a severe complication of drug administration with significant morbidity and mortality. So far no study in large population areas have examined the incidence, clinical profile and outcome of acute kidney injury (AKI)-MALA patients admitted in intensive care units (ICUs) and treated by renal replacement therapy (MALA-RRT). Methods: Retrospective analysis over a 6-year period (2010-2015) in Piedmont and Aosta Valley regions (5,305,940 inhabitants, 141,174 diabetics treated with metformin) of all MALA-RRT cases. Results: One hundred and seventeen cases of AKI-MALA-RRT were observed (12.04/100,000 metformin treated diabetics, 1.45% of all RRT-ICU patients). Survival rate was 78.3%. The average duration of RRT was 4.0 days at mean dialysis effluent of 977 mL/kg/day. At admission most patients were dehydrated, and experienced shock and oliguria. Conclusion: Our data showed that MALA-RRT is a common complication, needing more prevention. Adopted policy of early, extended, continuous and high efficiency dialysis could contribute to an observed high survival rate. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=471917.
- Published
- 2017
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