Am J Kidney Dis

Should metformin be stopped in advanced CKD?

February 19, 2025

Study details: This nationwide observational cohort study in Scotland included adults with T2DM who developed stage 4 CKD between January 2010 and April 2019. The study compared outcomes between patients who stopped vs. continued metformin within six months of CKD stage 4 diagnosis. The primary outcome was all-cause mortality, and secondary outcomes included major adverse cardiovascular events (MACE).

Results: Among 4,278 prevalent metformin users with incident stage 4 CKD, 1,713 (40.1%) discontinued metformin. Stopping metformin was associated with a lower 3-year survival rate (63.7% vs. 70.5%; hazard ratio [HR] 1.26; 95% confidence interval [CI] 1.10-1.44). The incidence of MACE was similar between groups (HR, 1.05; 95% CI, 0.88-1.26). Sensitivity analyses using marginal structural models confirmed the higher risk of all-cause mortality (HR, 1.34; 95% CI, 1.08-1.67) and similar risk of MACE (HR, 1.04; 95% CI, 0.81-1.33) in patients who stopped metformin.

Clinical impact: Continuing metformin in patients with advanced CKD may be associated with better survival outcomes without increasing cardiovascular risks. Further research is needed to confirm the findings.

Source:

Lambourg EJ, et al; Scottish Diabetes Research Network Epidemiology Group. (2025, February). Am J Kidney Dis. Stopping Versus Continuing Metformin in Patients With Advanced CKD: A Nationwide Scottish Target Trial Emulation Study. https://pubmed.ncbi.nlm.nih.gov/39521399/