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Correspondencia
Acidosis láctica por metformina: ¿debemos ser más cautelosos con la disfunción renal?
Metformin-induced lactic acidosis: Should we be more careful with renal dysfunction?
A.L. Blanco Taboadaa,
Autor para correspondencia
ana_laura_1992@hotmail.com

Autor para correspondencia.
, J. Castilla Yelámoa, S. Delgado Romeroa, J.L. García Garmendiab
a Servicio de Medicina Interna, Hospital San Juan de Dios de Aljarafe, Bormujos, Sevilla, España
b Servicio de Cuidados Críticos y Urgencias, Hospital San Juan de Dios de Aljarafe, Bormujos, Sevilla, España
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      "en" => array:1 [
        "titulo" => "Metformin-induced lactic acidosis&#58; Should we be more careful with renal dysfunction&#63;"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hemos le&#237;do con inter&#233;s el art&#237;culo de Boada Fern&#225;ndez del Campo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> sobre acidosis l&#225;ctica asociada a metformina &#40;ALAM&#41;&#44; donde los autores realizan un excelente an&#225;lisis sobre su asociaci&#243;n con la disfunci&#243;n renal aguda&#44; destacando los niveles de creatinina detectados en pacientes que ingresan con ALAM&#46; Sin embargo&#44; no se analiza el grado de disfunci&#243;n renal previa de los pacientes con metformina e hiperlactatemia&#44; que estar&#237;a claramente relacionado con esta complicaci&#243;n&#44; a veces fatal&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">En un estudio observacional retrospectivo desde enero de 2016 a junio de 2018 en el Hospital San Juan de Dios del Aljarafe&#44; un hospital comarcal que atiende 294&#46;000 habitantes&#44; con una prevalencia de uso de metformina de 430&#47;10&#46;000 habitantes&#47;a&#241;o&#44; analizamos 9&#46;283 episodios urgentes de pacientes tratados con metformina &#40;10&#44;6 episodios urgentes&#47;mes&#47;10&#46;000 habitantes&#41;&#46; Se detectaron 222 casos con lactato &#8805;<span class="elsevierStyleHsp" style=""></span>2&#44;7<span class="elsevierStyleHsp" style=""></span>mmol&#47;l&#46; En 56 casos se asoci&#243; hiperlactatemia con acidosis y fallo renal&#44; de los cuales en 17 &#40;30&#37;&#41; se diagnostic&#243; ALAM &#40;5&#44;4 casos&#47;10&#46;000 pacientes con metformina&#47;a&#241;o&#44; similar al estudio de Boada Fern&#225;ndez del Campo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a>&#41;&#46; De estos&#44; 10 ingresaron en la UCI precisando di&#225;lisis<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a>&#44; siendo la mortalidad global del 53&#37;&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> se muestran los filtrados glomerulares &#40;FG&#41; basales de los pacientes atendidos&#44; apreci&#225;ndose que un 35&#37; de los que presentaron hiperlactatemia&#44; un 53&#37; de los que asocian disfunci&#243;n renal y acidosis&#44; y un 76&#37; de los que desarrollan ALAM ten&#237;an disfunci&#243;n renal previa&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Observamos que la incidencia de hiperlactatemia en ambos estudios es mayor a la descrita en la ficha t&#233;cnica &#40;&#60;<span class="elsevierStyleHsp" style=""></span>1&#58;10&#46;000 expuestos&#41; y la comunicada en otros estudios<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a>&#46; Los datos de nuestro estudio confirman adem&#225;s&#44; que una proporci&#243;n elevada de los pacientes con hiperlactatemia asociada a uso de metformina tienen un FG basal &#60;<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#47;1&#44;73<span class="elsevierStyleHsp" style=""></span>m<span class="elsevierStyleSup">2</span>&#46; Conociendo la elevada mortalidad asociada&#44; consideramos que se deben extremar las precauciones en el manejo de metformina en pacientes con disfunci&#243;n renal<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a>&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pacientes con hiperlactatemia &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>222&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
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                            3 => "A&#46;M&#46; Aldea Perona"
                            4 => "E&#46;J&#46; Sanz &#193;lvarez"
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                      "titulo" => "Recomendaciones para el tratamiento de los pacientes cr&#237;ticos de los Grupos de Trabajo de la Sociedad Espa&#241;ola de Medicina Intensiva&#44; Cr&#237;tica y Unidades Coronarias &#40;SEMICYUC&#41;"
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                            3 => "J&#46;A&#46; Llompart-Pou"
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                      "titulo" => "Metformin-Associated Lactic Acidosis Undergoing Renal Replacement Therapy in Intensive Care Units&#58; A Five-Million Population-Based Study in the North-West of Italy"
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                  "referenciaCompleta" => "Use of metformin to treat diabetes now expanded to patients with moderately reduced kidney function&#46; Recommendations for patients with kidney impairment updated in product information&#46; European Medicines Agency&#44; Dec 2016&#59; 1-4&#46; Disponible en&#58; https&#58;&#47;&#47;www&#46;ema&#46;europa&#46;eu&#47;en&#47;documents&#47;referral&#47;metformin-article-31-referral-use-metformin-treat-diabetes-now-expanded-patients-moderately-reduced"
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Información del artículo
ISSN: 00142565
Idioma original: Español
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