Association of metformin use with risk of lactic acidosis in diabetic patients with chronic hepatitis B-related cirrhosis and different degrees of renal and liver impairment
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AbstractIntroduction: The risk of lactic acidosis associated with metformin use in cirrhotic patients with diabetes mellitus (DM) has not been clearly documented.

Objectives: We evaluated the association of metformin use with risk of lactic acidosis in DM patients with different severity of chronic hepatitis B (CHB)-related cirrhosis.

Methodology: We identified a territory-wide cohort of DM patients with CHB-related cirrhosis from January 2000 to December 2017 in Hong Kong. Lactic acidosis was defined by diagnosis codes, and/or blood pH <= 7.35 with lactate >5 mmol/L or arterial bicarbonate <=18 mmol/L or venous bicarbonate <=21 mmol/L. Liver and renal function were modelled by time-dependent Child-Pugh class and estimated glomerular filtration rate (eGFR) category. Comorbidities and use of medications were adjusted as time-dependent covariates. Patients with eGFR <30 mL/min/1.73 m2 or renal replacement therapy at baseline were excluded.

Results: 4,627 DM patients with CHB-related cirrhosis were identified; 2,762 (59.7%) had received metformin. At a median (interquartile range) follow-up of 5.3 (2.0–9.6) years, 1,119 (24.2%) patients developed lactic acidosis. The risk of lactic acidosis increased with degrees of liver and renal impairment (Figure). Use of metformin in Child-Pugh class A and eGFR \60 mL/min/1.73 m2 during follow-up was associated with an increased risk of lactic acidosis; Child-Pugh classes B and C during follow-up were associated with a higher risk of lactic acidosis (Table).

Conclusion: Metformin therapy is safe in DM patients with ChildPugh class A cirrhosis and eGFR <60 mL/min/1.73m2. The use of metformin in Child-Pugh classes B and C should be cautious at any eGFR level.
All Author(s) ListTerry Cheuk-Fung Yip, Vincent Wai-Sun Wong, Yee-Kit Tse, Henry Lik-Yuen Chan, Grace Lai-Hung Wong
Name of ConferenceThe Asian Pacific Association for the Study of the Liver (APASL) 2019 Annual Meeting
Start Date of Conference20/02/2019
End Date of Conference24/02/2019
Place of ConferenceManila
Country/Region of ConferencePhilippines
Proceedings TitleHepatology International
Year2019
Month2
Volume Number13
Issue NumberSuppl 1
PublisherSpringer
PagesS12 - S12
LanguagesEnglish-United Kingdom

Last updated on 2019-21-10 at 12:58