Evidence map›Paper›PMID 31471973›Full record

SynthesisBritish journal of clinical pharmacology2019

Is the use of metformin in patients undergoing dialysis hazardous for life? A systematic review of the safety of metformin in patients undergoing dialysis.

Christina Abdel Shaheed, Jane E Carland, Garry G Graham, Sophie L Stocker, Greg Smith, Mark Hicks, Kenneth M Williams, Timothy Furlong, Peter Macdonald, Jerry R Greenfield and 3 more

Open access · bronzeAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in British journal of clinical pharmacology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
1.4field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Review
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 6 institutions in 1 country.

Christina Abdel ShaheedSchool of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.ORCID 0000-0003-1258-5125
Jane E CarlandDepartment of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, Australia.
Garry G GrahamDepartment of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, Australia.ORCID 0000-0002-5602-0153
Sophie L StockerDepartment of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, Australia.
Greg SmithDepartment of Pharmacology, School of Medical Sciences, University of New South Wales, Sydney, Australia.
Mark HicksDepartment of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, Australia.
Kenneth M WilliamsDepartment of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, Australia.
Timothy FurlongDepartment of Nephrology, St Vincent's Hospital, Sydney, Australia.
Peter MacdonaldDepartment of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, Australia.
Jerry R GreenfieldSt Vincent's Clinical School, University of New South Wales, Sydney, Australia.ORCID 0000-0002-0866-0973
Felicity C SmithDepartment of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, Australia.
Gina ChowdhuryDepartment of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, Australia.
Richard O DayDepartment of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, Australia.
The University of Sydney · AUUNSW Sydney · AUSt Vincent's Hospital Melbourne · AUVictor Chang Cardiac Research Institute · AUGarvan Institute of Medical Research · AUSt Vincent's Hospital Sydney · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsMetformin may have clinical benefits in dialysis patients; however, its safety in this population is unknown. This systematic review evaluated the safety of metformin in dialysis patients.

methodsMEDLINE, Embase, CENTRAL, PsycINFO and the Cochrane Library were searched for randomised controlled trials and observational studies evaluating metformin use in dialysis patients. Three authors reviewed the studies and extracted data. The primary outcomes were mortality, occurrence of lactic acidosis and myocardial infarction (MI) in patients taking metformin during dialysis treatment for ≥12 months (long term). Risk of bias was assessed using Risk Of Bias In Nonrandomised Studies of Interventions (ROBINS-1). Overall quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

resultsFifteen observational studies were eligible; 7 were prospective observational studies and 8 were case reports/case series. No randomised controlled trials were identified. The 7 prospective observational studies (n = 194) reported on cautious metformin use in patients undergoing maintenance dialysis. Only 3 provided long-term follow-up data. In 2 long-term studies of metformin therapy (≤1000 mg/d) in patients undergoing peritoneal dialysis (PD), 1 reported 6 deaths (6/83; 7%) due to major cardiovascular events (3 MI) and the other reported no deaths (0/35). One long-term study of metformin therapy (250 mg to 500 mg thrice weekly) in patients undergoing haemodialysis reported 4 deaths (4/61; 7%) due to major cardiovascular events (2 MI). These findings provide very low-quality evidence as they come from small observational studies.

conclusionThe evidence regarding the safety of metformin in people undergoing dialysis is inconclusive. Appropriately designed randomised controlled trials are needed to resolve this uncertainty.

Indexed as

Renal DialysisAcidosisDiabetes Mellitus, Type 2Drug MonitoringHumansHypoglycemic AgentsKidneyKidney DiseasesLactic AcidMetforminHypoglycemic AgentsLactic AcidMetformindialysislactic acidosismetforminmortalitysystematic review

Identifiers

PMID31471973
PMCPMC6955402
OpenAlexW2970853389

What Socratic holds

Texttitle and abstract
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.