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Association of Metformin Use With End‐Stage Renal Disease in Patients With Type 2 Diabetes Mellitus: A Nationwide Cohort Study Under the Pay‐for‐Performance Program
- Source :
- The Journal of Clinical Pharmacology. 59:1443-1452
- Publication Year :
- 2019
- Publisher :
- Wiley, 2019.
-
Abstract
- Animal studies have demonstrated that metformin exerts a renoprotective effect. Human studies of patients with diabetes mellitus (DM) regarding the association of metformin use with end-stage renal disease (ESRD) are lacking. Patients with type 2 DM and without a history of kidney disease who were enrolled under the pay-for-performance program of the National Health Insurance in Taiwan were identified. Those who received ≥90 cumulative defined daily doses of metformin within 1 year were selected (metformin users) and compared with a 1:1 propensity score-matched metformin nonuser cohort. Primary and secondary outcomes were development of ESRD and chronic kidney disease (CKD), respectively. Independent predictors were investigated using Cox regression analysis. A total of 24 158 pairs of metformin users and nonusers were enrolled, with an incidence of ESRD of 1908 and 1723 and CKD of 1095 and 1056 cases per 100 000 person-years, respectively. Metformin use was independently associated with increased risks of ESRD (adjusted hazard ratio, 1.22; 95% confidence interval, 1.12-1.32) and CKD (adjusted hazard ratio, 1.25; 95% confidence interval, 1.12-1.40) in a dose-response relationship. Patients with hypertension plus nonuse of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers potentiated kidney damage by metformin. In patients with DM, use of metformin may increase the risk of ESRD and CKD. Health care professionals should be alert and closely monitor renal function when prescribing metformin.
- Subjects :
- Adult
Male
medicine.medical_specialty
endocrine system diseases
Taiwan
urologic and male genital diseases
030226 pharmacology & pharmacy
End stage renal disease
03 medical and health sciences
0302 clinical medicine
Risk Factors
Diabetes mellitus
Internal medicine
medicine
Humans
Hypoglycemic Agents
Pharmacology (medical)
Aged
Retrospective Studies
Aged, 80 and over
Pharmacology
business.industry
Incidence
Hazard ratio
nutritional and metabolic diseases
Type 2 Diabetes Mellitus
Middle Aged
medicine.disease
Metformin
Diabetes Mellitus, Type 2
030220 oncology & carcinogenesis
Cohort
Kidney Failure, Chronic
Female
business
Kidney disease
Cohort study
medicine.drug
Subjects
Details
- ISSN :
- 15524604 and 00912700
- Volume :
- 59
- Database :
- OpenAIRE
- Journal :
- The Journal of Clinical Pharmacology
- Accession number :
- edsair.doi.dedup.....198accf47382f77e60ef735c684fd3fb