Regional citrate anticoagulation ensures safe and effective kidney replacement therapy in metformin-associated lactic acidosis.

ABSTRACT:

Background

Metformin-associated lactic acidosis (MALA) is a rare but potentially life-threatening complication of metformin therapy, often associated with acute kidney injury (AKI). Sustained low-efficiency dialysis (SLED) offers both haemodynamic stability and effective metformin clearance. However, during regional citrate anticoagulation (RCA), concerns may arise regarding citrate accumulation due to metformin-induced impairment of cellular metabolism. This study assesses the efficacy and safety of SLED with RCA in the management of MALA, providing direct measurements of serum metformin and citrate levels to evaluate drug clearance and potential citrate accumulation.

Methods

A prospective observational study was conducted on consecutive critically ill patients with severe

SUBMITTER: Di Mario F 

PROVIDER: S-EPMC12508805 | biostudies-literature | 2025 Oct

REPOSITORIES: biostudies-literature