Submitted: 10 Apr 2019
Accepted: 07 Jun 2019
First published online: 29 Jun 2019
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J Renal Inj Prev. 2019;8(3):185-189.
doi: 10.15171/jrip.2019.34
  Abstract View: 279
  PDF Download: 190


Continuation or termination of metformin in diabetic patients exposed to iodinated contrast medium?

Mohamad Ali Dayani * ORCiD

1 Department of Radiology, Shahrekord University of Medical Sciences, Shahrekord, Iran
*Corresponding author: Mohamad Ali Dayani, Email:, Email:


Lactic acidosis (LA) secondary to metformin administration is a rare incident with a very highmortality rate (≥50%). Hypoxia has been suggested to contribute to metformin-associatedlactic acidosis (MALA) in 90% of patients developing this condition. In susceptible patientssuch as those with renal insufficiency, the level of plasma metformin is increased particularlyafter exposure to iodinated contrast media (ICM). One major concern in patients with renalinsufficiency is to adjust the metformin dose based on the renal functional capacity prior to ICMexamination. In this review, we assessed metformin tolerable threshold in diabetic patients withrenal failure. We also reviewed metformin withdrawal criteria in patients with chronic kidneydisease (CKD) exposed to intravenous ICM during angiography. Our results indicated that inpatients with insufficient renal function (i.e. 30< estimated glomerular filtration rate(eGFR) <60and 30<eGFR<45 mL/min/1.73 m2), or those with acceptable renal function (eGFR ≥60 mL/min/1.73 m2) and concomitant comorbidities, the decision to withhold or reinitiate metforminshould be based on patient’s medical condition.

Implication for health policy/practice/research/medical education:

It has been recommended that in patients with compromised renal function (i.e. 30< eGFR <60 and 30<eGFR<45 mL/ min/1.73m2) and those with normal renal function and other co-morbidities, either withholding or continuing of metformin prior toiodinated contrast medium exposure should be based on patient’s medical condition.

Please cite this paper as: Dayani MA. Continuation or termination of metformin in diabetic patients exposed to iodinatedcontrast medium? J Renal Inj Prev. 2019;8(3):185-189. DOI: 10.15171/jrip.2019.34.

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