View Full Chapter Figures Only Tables Only Videos Only Print Get Citation Citation AMA Citation Hui C, Shroff D. Hui C, Shroff D Hui, Caitlyn, and Deepti Shroff. "Metformin associated with reduced mortality in kidney disease, congestive heart failure, and chronic liver disease." 2 Minute Medicine, 4 January 2015. McGraw-Hill, New York, NY, 2015. AccessMedicine. http://accessmedicine.mhmedical.com/updatesContent.aspx?gbosid=324938§ionid=149400702 MLA Citation Hui C, Shroff D. Hui C, Shroff D Hui, Caitlyn, and Deepti Shroff.. "Metformin associated with reduced mortality in kidney disease, congestive heart failure, and chronic liver disease." 2 Minute Medicine New York, NY: McGraw-Hill, 2015, http://accessmedicine.mhmedical.com/updatesContent.aspx?gbosid=324938§ionid=149400702. Download citation file: RIS (Zotero) EndNote BibTex Medlars ProCite RefWorks Reference Manager Mendeley © Copyright Top Return Clip Autosuggest Results Metformin associated with reduced mortality in kidney disease, congestive heart failure, and chronic liver disease by Caitlyn Hui, Deepti Shroff +Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission. +1. Metformin use is associated with reduced all-cause mortality in patients with chronic kidney disease, congestive heart failure, or chronic liver disease with hepatic impairment. +2. In this systemic review, fewer heart failure readmissions were observed in patients with CKD or CHF that were treated with metformin. +Evidence Rating Level: 1 (Excellent) +Metformin is currently the suggested initial treatment for type 2 diabetes mellitus in the United States. In the past, the U.S. Food and Drug Administration (FDA did not recommend metformin for patients with chronic kidney disease (CKD), congestive heart failure (CHF), and/or chronic liver disease (CLD) with hepatic impairment. However, these recommendations were removed in 2006 due to the notion that the precautions were too restrictive. The purpose of this study, therefore, was to promote fully informed prescribing by synthesizing data addressing outcomes of metformin in these populations with historical contraindications. The authors concluded that metformin use in patients with moderate CKD, CHF, or CLD with hepatic impairment is associated with improvements in key clinical outcomes. There were several limitations to this study. First, not all outcomes of potential interest were evaluated. Additionally, strength of evidence was low and studies varied in follow-up duration. Overall, the results of this study support changes in metformin labeling to permit metformin use in additional patients with certain types of CHF, CKD, and CLD with hepatic impairment. +Click to read the study, published today in the Annals of Internal Medicine +Relevant Reading: Metformin in Chronic Kidney Disease: Time for a Rethink In-Depth [systematic review]: + +In this systematic review, articles were retrieved from MEDLINE, EMBASE, and International Pharmaceutical Abstracts from 1994 to 2015/16. 4910 citations were screened and 532 full-text articles were assessed. From these articles, 2 reviewers abstracted data and independently rated study quality and strength of evidence from 17 observational studies included in the analysis. Based on the available evidence from these studies, metformin therapy was found to be associated with reduced all-cause mortality among patients with moderate CKD, CHF, or CLD with impaired hepatic function. Specifically, 11 studies examined all-cause mortality. On meta-analysis, the relative chance of dying during follow-up was 22% lower for patients receiving metformin than for those that did not receive it (HR 0.78; CI 0.71 to 0.87, p = 0.003). +©2016 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.