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      Serum lactate level and mortality in metformin-associated lactic acidosis requiring renal replacement therapy: a systematic review of case reports and case series

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          Abstract

          Background

          The current practice concerning timing, mode, and dose of renal replacement therapy (RRT) in patients with metformin-associated lactic acidosis (MALA) with renal failure remains unknown. To investigate whether serum lactate level and prescription pattern of RRT are associated with mortality in patients with MALA requiring RRT.

          Methods

          We searched PubMed/Medline and EMBASE from inception to Sep 2014 and applied predetermined exclusion criteria. Case-level data including case’s demographics and clinical information related to MALA were abstracted. Multiple logistic regression modeling was used to examine the predictors of mortality.

          Results

          A total of 253 unique cases were identified with cumulative mortality of 17.2%. Eighty-seven percent of patients had acute kidney injury. Serum lactate level was significantly higher in non-survivors (median 22.5 mmol/L) than in survivors (17.0 mmol/L, p-value <0.01) and so did the median blood metformin concentrations (58.5 vs. 43.9 mg/L, p-value = 0.05). The survival advantage was not significantly different between the modalities of RRT. The adjusted odds ratio of mortality for every one mmol/L increase in serum lactate level was 1.09 (95% CI 1.02–1.17, p-value = 0.01). The dose-response curve indicated a lactate threshold greater than 20 mmol/L was significantly associated with mortality.

          Conclusions

          Our study suggests that predialysis level of serum lactate level is an important marker of mortality in MALA patients requiring RRT with a linear dose-response relationship. To better evaluate the optimal prescription of RRT in MALA, we recommend fostering an international consortium to support prospective research and large-scale standardized case collection.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12882-017-0640-4) contains supplementary material, which is available to authorized users.

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          Most cited references19

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          Polycystic Ovary Syndrome

          New England Journal of Medicine, 352(12), 1223-1236
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            Metformin.

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              Lactic acidosis.

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                Author and article information

                Contributors
                hcyeh@pie.com.tw
                iwting2010@gmail.com
                cwtsai2007@gmail.com
                wujennyu@gmail.com
                886.4.2205.2121-2910 , chinchik@gmail.com
                Journal
                BMC Nephrol
                BMC Nephrol
                BMC Nephrology
                BioMed Central (London )
                1471-2369
                10 July 2017
                10 July 2017
                2017
                : 18
                : 229
                Affiliations
                [1 ]ISNI 0000 0001 0083 6092, GRID grid.254145.3, Kidney Institute and Division of Nephrology, Department of Internal Medicine, , China Medical University Hospital and College of Medicine, China Medical University, ; 2, Yude Rd., North Dist, Taichung City, 404 Taiwan
                [2 ]ISNI 0000 0001 0083 6092, GRID grid.254145.3, Big Data Center, China Medical University Hospital and College of Medicine, , China Medical University, ; Taichung, Taiwan
                [3 ]ISNI 0000 0004 0572 7815, GRID grid.412094.a, Department of Internal Medicine, , National Taiwan University Hospital Yun-Lin Branch, ; Yun-Lin, Taiwan
                Article
                640
                10.1186/s12882-017-0640-4
                5504722
                28693440
                367cb23a-7636-4c25-867a-c2f951ca9ba5
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 30 December 2016
                : 26 June 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100004663, Ministry of Science and Technology, Taiwan;
                Award ID: 105-2314-B-039 -040
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Nephrology
                metformin,acute kidney injury,metabolic acidosis,renal replacement therapy,lactate
                Nephrology
                metformin, acute kidney injury, metabolic acidosis, renal replacement therapy, lactate

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