Evidence mapPaperPMID 41254555Full record

SynthesisBMC nephrology2025

Metformin in non-diabetic patients with autosomal dominant polycystic kidney disease: a systematic review and meta-analysis of randomized controlled trials.

Vitor Almeida, Lucas Maciel, Ana Beatriz Valverde Ramos, Carla Sousa, Maria Ferraz, Luisalice Afonso, Paula Dibo, Ivana Nunes

Abstract readSystematic ReviewMeta-Analysis
In one paragraph

Synthesis in BMC nephrology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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4 · The record

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5 · Who and what money

Authors and funding

8 authors.

Vitor AlmeidaFederal University of Catalão, Catalão, Goiás, Brazil. vitorpaivadealmeida@gmail.com.
Lucas MacielGeneral Hospital of Goiânia, Goiânia, Goiás, Brazil.
Ana Beatriz Valverde RamosPontifical Catholic University of Paraná, Paraná, Curitiba, Brazil.
Carla SousaJean Piaget University at Angola, Luanda, Angola.
Maria FerrazVila Velha University, Vila Velha, Espírito Santo, Brazil.
Luisalice AfonsoFederal University of Cariri, Ceará, Brazil.
Paula DiboDivision of General Internal Medicine, Department of Medicine, Emory University, Atlanta, Ga, USA.
Ivana NunesDivision of Nephrology, Department of Internal Medicine, General Hospital of Goiânia, Goiás, Brazil.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionAutosomal dominant polycystic kidney disease (ADPKD), which is caused mainly by mutations in the PKD1 or PKD2 genes, is a genetic disorder characterized by the growth of cysts and decreased kidney function. There is limited evidence on pharmacological interventions capable of slowing down disease progression in non-diabetic patients. Metformin, widely used to treat type 2 diabetes, has shown potential nephroprotective effects through activation of AMPK and inhibition of the mTOR pathway.

methodsPubMed, Embase and Cochrane databases were searched for randomized clinical trials (RCTs) comparing metformin versus placebo or standard care in non-diabetic patients with ADPKD. Standardized mean differences (SMDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated via random-effects model. Heterogeneity was assessed using the I2 test. Statistical analyses were performed using Review Manager, version 5.4, and R Software, version 4.4.2.

resultsFour RCTs were included, comprising 213 patients. Average follow-up ranged from 0.15 to 2 years. No significant differences were observed in the decline of kidney function (SMD: 0.19; 95% CI, −0.08 to 0.46; p = 0.17) or in height-adjusted total kidney volume (htTKV) progression (SMD: 0.09; 95% CI, −0.20 to 0.38; p = 0.53). Gastrointestinal adverse events were more frequent in the metformin group (RR: 2.93; 95% CI, 1.51 to 5.67; p = 0.0014), while the incidence of hypoglycemia did not differ between groups (RR: 1.04; 95% CI, 0.36 to 3.00; p = 0.948). The pooled prevalence of tolerability-related discontinuation or dose reduction due to adverse effects was 37.38% (95% CI: 12.15 to 72.04%).

conclusionThis meta-analysis suggests that metformin does not significantly affect the rate of kidney function decline in non-diabetic patients with ADPKD. Its impact on kidney volume remains uncertain, while gastrointestinal symptoms, although more common, were generally mild. However, interpretation is limited by the small number of trials, modest sample sizes, and relatively short follow-up durations, which reduce the ability to assess long-term outcomes. Larger and longer studies are needed to clarify the potential role of metformin in this population. CLINICAL

trial registrationNot applicable. REGISTRATION: PROSPERO CRD420251062402.

Indexed as

Hypoglycemic AgentsMetforminPolycystic Kidney, Autosomal DominantHumansRandomized Controlled Trials as TopicTreatment OutcomeHypoglycemic AgentsMetforminAutosomal dominant polycystic kidney diseaseHeight-adjusted total kidney volumeKidney function rate declineMetformin

Identifiers

PMID41254555
PMCPMC12625526

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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.