Kidney Research and Clinical Practice 2020 Mar; 39(1): 32-39  
Metformin treatment for patients with diabetes and chronic kidney disease: A Korean Diabetes Association and Korean Society of Nephrology consensus statement
Kyu Yeon Hur1,* , Mee Kyoung Kim2,* , Seung Hyun Ko3 , Miyeun Han4 , Dong Won Lee5 , Hyuk-Sang Kwon2 , Committee of Clinical Practice Guidelines, Korean Diabetes Association and Committee of the Cooperative Studies, Korean Society of Nephrology
1Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
2Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
3Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Republic of Korea
4Division of Nephrology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
5Division of Nephrology, Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
Correspondence to: Dong Won Lee
Division of Nephrology, Department of Internal Medicine, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeumeup, Yangsan 50612, Republic of Korea. E-mail: dongwonlee@pusan.ac.kr
Hyuk-Sang Kwon
Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 10 63-ro, Yeongdeungpo-gu, Seoul 07345, Republic of Korea. E-mail: drkwon@catholic.ac.kr
*Kyu Yeon Hur and Mee Kyoung Kim contributed equally to this study as first authors.

Edited by Gheun-Ho Kim, Hanyang University, Seoul, Republic of Korea
Received: January 21, 2020; Revised: February 3, 2020; Accepted: February 9, 2020; Published online: March 31, 2020.
© The Korean Society of Nephrology. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
The safety of metformin use for patients with type 2 diabetes mellitus (T2DM) and advanced kidney disease is controversial, and more recent guidelines have suggested that metformin be used cautiously in this group until more definitive evidence concerning its safety is available. The Korean Diabetes Association and the Korean Society of Nephrology have agreed on consensus statements concerning metformin use for patients with T2DM and renal dysfunction, particularly when these patients undergo imaging studies using iodinated contrast media (ICM). Metformin can be used safely when the estimated glomerular filtration rate (eGFR) is ≥ 45 mL/min/1.73 m2. If the eGFR is between 30 and 44 mL/min/1.73 m2, metformin treatment should not be started. If metformin is already in use, a daily dose of ≤ 1,000 mg is recommended. Metformin is contraindicated when the eGFR is < 30 mL/min/1.73 m2. Renal function should be evaluated prior to any ICM-related procedures. During procedures involving intravenous administration of ICM, metformin should be discontinued starting the day of the procedures and up to 48 hours post-procedures if the eGFR is < 60 mL/min/1.73 m2.
Keywords: Contrast media, Diabetes mellitus, Metformin, Renal insufficiency


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