Autori: Piero Lisi, Luigi Rossi, Pasquale Libutti, Annalisa Teutonico, Carlo Lomonte
Affiliazioni: U.O.C. Nefrologia e Dialisi – Ente Ecclesiastico – Ospedale Generale Regionale Miulli – Acquaviva delle Fonti (BA)
BACKGORUND: Metformin-Associated Lactic Acidosis (MALA) is a severe complication for patient with type 2 diabetes mellitus with infection, often associated with Acute Kidney Injury (AKI). Early renal replacement therapy rather than simple acidosis correction by administration of alkali seems the treatment of choice for renal recovery and overall outcome.
METHODS: We report a case series of one year period (2017) in our Nephrology Unit of 8 diabetic patients with AKI-MALA, that require renal replacement therapy, not in ICU, treated with Sustained Low Efficiency Dialysis (SLED) by the GENIUS dialysis system.
RESULTS: Eight AKI-MALA patients were observed. They were diabetic, with a basal mean creatinine before admission of 0.97±0.37 mg/dl. Mean age and duration of diabetes were 72.75±9.22 and 15.75±7.92 years respectively. Other that metformin, mean daily taken amount of 2.78 g, most of patients took diuretics and Ace-i/sartans. Everyone at admission had an infection, dehydratation symptoms, severe acidosis and AKI (Stage 3 of AKIN criteria; stage of Failure by RIFLE stadiation). Mean creatinine, PH and Lactate were respectively 6.13±1.72 mg/dl, 7.10±0.1, 12.65±3.94 mmol/L. All patients underwent a SLED session within two hours from the admission in the hospital, until normalization of serum lactate and PH value (mean 1.51±0.21 mmol/L, 7.38±0.03 respectively). Mean duration of the treatment was 16±7.4 hours. One patient died three hours after the beginning of dialysis. Survival patients had complete recovery of renal function (mean creatinine at discharge 1.24±0.58 mg/dl).
CONCLUSIONS: MALA with AKI is a severe and life-threatening complication for diabetic patients. A timely treatment with SLED may have an high survival rate and good recovery of renal function.