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Article title

Miejsce metforminy w leczeniu cukrzycy u pacjentów z przewlekłą chorobą nerek

Title variants
Metformin treatment in diabetic patients with chronic kidney disease
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Metformin is a fi rst line drug in type 2 diabetes treatment, and has several proven benefi ts including the reduction of acute cardiovascular episodes, which are the main cause of death in diabetic patients. Nevertheless, the use of metformin in diabetic patients suff ering from chronic renal failure is limited due to its pharmacokinetic profi le due to the potential risk of lactic acidosis. Lactic acidosis is a rare complication (the same risk in patients with or without metformin treatment) that can potentially appear especially when oxygen defi ciency takes place. It seems that in some patients with stable chronic kidney disease and no serious history of other diseases, we might widen the therapeutic indications for prescribing metformin since there are defi nitely more benefi ts of using metformin than its early withdrawal from therapy. Some diabetological associations seem to liberalize the therapeutic indications for using metformin and arbitrally recommend prescribing this drug to patients with mild to moderate renal kidney disease. It seems that more evidence-based medical studies are necessary to carefully assess the role of metformin treatment in patients with severe renal failure. We hope that prospective, randomized studies planned to assess the effi cacy and safety of metformin in diabetic patients with diff erent stages of chronic renal failure will be performed soon.
Metformina jest lekiem pierwszego rzutu w leczeniu cukrzycy typu 2. Do udowodnionych korzyści jej stosowania należy zmniejszenie liczby incydentów sercowo-naczyniowych, stanowiących najczęstszą przyczynę zgonów u chorych z cukrzycą. U chorych z przewlekłą chorobą nerek metforminę – ze względu na profi l farmakokinetyczny – ogranicza ryzyko wystąpienia kwasicy mleczanowej. Przedstawione wyniki badań pokazują, że kwasica mleczanowa jest bardzo rzadkim powikłaniem stosowania metforminy występującym z podobną częstością jak u chorych przyjmujących inne leki. Pojawienie się tego powikłania często było uwarunkowane współistnieniem dodatkowych czynników ryzyka prowadzących do niedotlenienia organizmu. Wydaje się, że u niektórych pacjentów, szczególnie ze stabilną chorobą nerek, bez obciążającego wywiadu, należy rozszerzyć wskazania do podawania metforminy, gdyż potencjalne ryzyko groźnych powikłań z tym związanych jest o wiele mniejsze niż po jej przedwczesnym odstawieniu. W zaleceniach wydawanych przez niektóre towarzystwa diabetologiczne zauważa się tendencję do liberalizacji wskazań do jej stosowania w leczeniu łagodnej i umiarkowanej postaci przewlekłej choroby nerek, wydaje się jednak, iż mają one charakter arbitralny. Rzetelna ocena możliwości stosowania metforminy u chorych w bardziej zaawansowanym stadium choroby nerek wymaga dalszych badań. Być może w przyszłości zostaną podjęte prospektywne, zrandomizowane badania z metforminą u chorych w różnych stadiach przewlekłej choroby nerek.
Physical description
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