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Metformin initiation and renal impairment: a cohort study in Denmark and the UK

OBJECTIVES: To estimate prevalence of renal impairment, rate of decline in kidney function and changes in metformin use after decline in kidney function, in metformin initiators. DESIGN, SETTING AND PARTICIPANTS: We conducted this 2-country cohort study using routine data from northern Denmark and t...

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Autores principales: Christiansen, Christian Fynbo, Ehrenstein, Vera, Heide-Jørgensen, Uffe, Skovbo, Stine, Nørrelund, Helene, Sørensen, Henrik Toft, Li, Lin, Jick, Susan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4563232/
https://www.ncbi.nlm.nih.gov/pubmed/26338686
http://dx.doi.org/10.1136/bmjopen-2015-008531
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author Christiansen, Christian Fynbo
Ehrenstein, Vera
Heide-Jørgensen, Uffe
Skovbo, Stine
Nørrelund, Helene
Sørensen, Henrik Toft
Li, Lin
Jick, Susan
author_facet Christiansen, Christian Fynbo
Ehrenstein, Vera
Heide-Jørgensen, Uffe
Skovbo, Stine
Nørrelund, Helene
Sørensen, Henrik Toft
Li, Lin
Jick, Susan
author_sort Christiansen, Christian Fynbo
collection PubMed
description OBJECTIVES: To estimate prevalence of renal impairment, rate of decline in kidney function and changes in metformin use after decline in kidney function, in metformin initiators. DESIGN, SETTING AND PARTICIPANTS: We conducted this 2-country cohort study using routine data from northern Denmark and the UK during 2000–2011. We included metformin initiators among patients aged ≥30 years with medically treated diabetes. MAIN OUTCOME MEASURES: We described patients’ demographics, comorbidity, co-medications and their estimated glomerular filtration rates (eGFR). Furthermore, we described the patients’ characteristics according to eGFR level. Finally, we examined the rate of any decline in eGFR and changes in metformin use within 90 days after first decline in eGFR during follow-up. RESULTS: We included 124 720 metformin initiators in the 2 countries. Prevalence of eGFR <60 mL/min/1.73 m(2) among metformin initiators was 9.0% in Denmark and 25.2% in the UK. In contrast, prevalence of eGFR values <30 mL/min/1.73 m(2) among metformin initiators was 0.3% in Denmark and 0.4% in the UK. Patients with renal impairment were older and more likely to have received cardiovascular drugs. Incidence rate of decline in renal function was 4.92 per 100 person-years (95% CI 4.76 to 5.09) in Denmark and 7.48 per 100 person-years (95% CI 7.39 to 7.57) in the UK. The proportion of patients continuing metformin use, even after a first decline brought the eGFR below 30 mL/min/1.73 m(2), was 44% in Denmark and 62% in the UK. There was no clinically significant dose reduction with decreasing baseline eGFR level discernible from the data. CONCLUSIONS: Mild to moderate renal impairment was common among metformin initiators, while severe renal impairment was uncommon. Patients with severe renal impairment frequently continued receiving/redeeming metformin prescriptions even 90 days after eGFR decline.
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spelling pubmed-45632322015-09-14 Metformin initiation and renal impairment: a cohort study in Denmark and the UK Christiansen, Christian Fynbo Ehrenstein, Vera Heide-Jørgensen, Uffe Skovbo, Stine Nørrelund, Helene Sørensen, Henrik Toft Li, Lin Jick, Susan BMJ Open Diabetes and Endocrinology OBJECTIVES: To estimate prevalence of renal impairment, rate of decline in kidney function and changes in metformin use after decline in kidney function, in metformin initiators. DESIGN, SETTING AND PARTICIPANTS: We conducted this 2-country cohort study using routine data from northern Denmark and the UK during 2000–2011. We included metformin initiators among patients aged ≥30 years with medically treated diabetes. MAIN OUTCOME MEASURES: We described patients’ demographics, comorbidity, co-medications and their estimated glomerular filtration rates (eGFR). Furthermore, we described the patients’ characteristics according to eGFR level. Finally, we examined the rate of any decline in eGFR and changes in metformin use within 90 days after first decline in eGFR during follow-up. RESULTS: We included 124 720 metformin initiators in the 2 countries. Prevalence of eGFR <60 mL/min/1.73 m(2) among metformin initiators was 9.0% in Denmark and 25.2% in the UK. In contrast, prevalence of eGFR values <30 mL/min/1.73 m(2) among metformin initiators was 0.3% in Denmark and 0.4% in the UK. Patients with renal impairment were older and more likely to have received cardiovascular drugs. Incidence rate of decline in renal function was 4.92 per 100 person-years (95% CI 4.76 to 5.09) in Denmark and 7.48 per 100 person-years (95% CI 7.39 to 7.57) in the UK. The proportion of patients continuing metformin use, even after a first decline brought the eGFR below 30 mL/min/1.73 m(2), was 44% in Denmark and 62% in the UK. There was no clinically significant dose reduction with decreasing baseline eGFR level discernible from the data. CONCLUSIONS: Mild to moderate renal impairment was common among metformin initiators, while severe renal impairment was uncommon. Patients with severe renal impairment frequently continued receiving/redeeming metformin prescriptions even 90 days after eGFR decline. BMJ Publishing Group 2015-09-02 /pmc/articles/PMC4563232/ /pubmed/26338686 http://dx.doi.org/10.1136/bmjopen-2015-008531 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Diabetes and Endocrinology
Christiansen, Christian Fynbo
Ehrenstein, Vera
Heide-Jørgensen, Uffe
Skovbo, Stine
Nørrelund, Helene
Sørensen, Henrik Toft
Li, Lin
Jick, Susan
Metformin initiation and renal impairment: a cohort study in Denmark and the UK
title Metformin initiation and renal impairment: a cohort study in Denmark and the UK
title_full Metformin initiation and renal impairment: a cohort study in Denmark and the UK
title_fullStr Metformin initiation and renal impairment: a cohort study in Denmark and the UK
title_full_unstemmed Metformin initiation and renal impairment: a cohort study in Denmark and the UK
title_short Metformin initiation and renal impairment: a cohort study in Denmark and the UK
title_sort metformin initiation and renal impairment: a cohort study in denmark and the uk
topic Diabetes and Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4563232/
https://www.ncbi.nlm.nih.gov/pubmed/26338686
http://dx.doi.org/10.1136/bmjopen-2015-008531
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