Association between ACEI/ARB Usage and Occurrence of Metformin-associated Lactic Acidosis (MALA) in Diabetic Patients, A Case-control Study
Atis Smithiphol, MD1, Phitphiboon Deawtrakulchai, MD1,2
Affiliation : 1Division of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand, 2Sub-Division of Critical Care, Division of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Background: Metformin-associated lactic acidosis (MALA), though not common, is a life-threatening complication of drug administration. An important precipitating cause of MALA is renal impairment, which can occur after angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB) usage.
Objective: To determine the association between ACEI/ARB usage and the development of MALA.
Materials and Methods: A 1: 5 matched case-control study among patients admitted to a medical intensive care unit with MALA. One hundred forty Controls were matched for age, sex, and metformin dose.
Results: Among 28 cases of MALA, 60.71% were female, the median (IQR) of patient age was 69.50 (61 to 76) years, and the median daily dose of metformin was 2,000 (1,500, 2,000) mg. All of them had acute kidney injury on admission. Initial and maximum serum lactate levels were 17.79 (11.28, 19.79) and 20.58 (16.24, 26.50) mmol/L, respectively, with an initial pH of 7.01 (6.94, 7.18). Mortality rate was 21.43%. The concomitant ACEI/ARB usage was not statistically different between cases (50%) and controls (54.29%) with an odds ratio of 0.84 (p=0.68, 95% CI 0.37 to 1.90).
Conclusion: ACEI/ARB usage was not associated with MALA occurrence.
Keywords : Metformin-associated lactic acidosis; MALA; Angiotensin-converting enzyme inhibitor; Angiotensin receptor blocker; ACEI; ARB; Diabetes mellitus
