Pharmacy Clinical Pearl of the Day: Metformin and Kidney Function in Diabetes

Clinical Pearl of the Day:

If a patient has diabetes, with metformin onboard as a treatment option, and GFR (kidney function) is below <30, metformin should be discontinued.

Explanation:

• Do not use metformin among patients with an eGFR less than 30.
• Do not start metformin among patients with an eGFR between 30 and 45.
• Stop metformin if a patient’s eGFR drops less than at any point during therapy.
• Complete a risk-benefit analysis of metformin if a patient’s eGFR drops to less than 45.
• Because metformin is renally cleared, it may cause some concern about nephrotoxicity, especially lactic acidosis, in patients with impaired renal function.

Reference: Metformin and Renal Function (diabeteseducator.org)