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학술저널
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김민호 (이화여자대학교) Oh Hyung Jung (Department of Nephrology Sheikh Khalifa Specialty Hospital Ras AlKhaimah UAE.) 권순효 (순천향대학교) 전진석 (중앙대학교) 노현진 (순천향대학교) 한동철 (순천향대학교) 김형래 (순천향대학교) Ryu Dong-Ryeol (Ewha Womans University)
저널정보
대한신장학회 Kidney Research and Clinical Practice Kidney Research and Clinical Practice Vol.40 No.4
발행연도
2021.12
수록면
660 - 672 (13page)
DOI
10.23876/j.krcp.20.222

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Background: Metformin has recently been shown not to increase the risk of lactic acidosis in patients with chronic kidney disease (CKD). Thus, the criteria for metformin use in this population has expanded. However, the relationship between metformin use and clinical outcomes in CKD remains controversial. Methods: This study considered data from 97,713 diabetes patients with an estimated glomerular filtration rate of <60 mL/min/1.73 m2. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), and the secondary outcomes were all- cause mortality and incident end-stage renal disease (ESRD). Results: Metformin users had a significantly higher risk of MACCE than non-users (hazard ratio [HR], 1.20; 95% confidence interval [CI], 1.14?1.26; p < 0.001). However, metformin users had a lower risk of all-cause mortality (HR, 0.78; 95% CI, 0.74?0.81; p < 0.001) and ESRD (HR, 0.44; 95% CI, 0.42?0.47; p < 0.001) during follow-up than non-users did. The relationships between met- formin use and clinical outcomes remained consistent in propensity score matching analyses and subgroup analyses of patients with adequate adherence to anti-diabetes medication. Conclusion: Treatment with metformin was associated with an increased risk of MACCE in patients with diabetes and CKD. However, metformin users had a lower risk of all-cause mortality and ESRD during follow-up than non-users did. Therefore, metformin needs to be carefully used in patients with CKD.

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