From the Guidelines
When kidney function declines to 30% (eGFR around 30 ml/min/1.73m²), metformin should be discontinued due to the increased risk of lactic acidosis, as recommended by the 2020 KDIGO clinical practice guideline for diabetes management in chronic kidney disease 1.
Medications to Discontinue or Adjust
The following medications should be discontinued or adjusted when kidney function declines to 30%:
- Metformin: discontinue due to increased risk of lactic acidosis 1
- NSAIDs (ibuprofen, naproxen, diclofenac): discontinue to prevent worsening kidney function and fluid retention
- Certain antibiotics (nitrofurantoin, aminoglycosides): avoid due to potential kidney damage
- High-potassium medications (potassium-sparing diuretics, potassium supplements): discontinue to prevent hyperkalemia
- Some bisphosphonates for osteoporosis and gadolinium-based contrast agents: avoid due to potential kidney damage
Medications Requiring Dose Adjustments
The following medications may require dose adjustments when kidney function declines to 30%:
- Antihypertensives: adjust dose as needed to maintain blood pressure control
- Statins: adjust dose as needed to maintain lipid control
- Some antibiotics: adjust dose as needed to maintain efficacy and prevent toxicity
Important Considerations
It is essential to consult with a nephrologist or healthcare provider before stopping or adjusting any medication, as individual circumstances may vary. The kidneys play a crucial role in eliminating many drugs from the body, and reduced kidney function can lead to drug accumulation and toxicity. Regular monitoring of kidney function and medication adjustments can help prevent adverse outcomes and improve patient outcomes 1.
From the FDA Drug Label
Metformin hydrochloride tablets are contraindicated in severe renal impairment, patients with an estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m 2 The medication that is discontinued with impaired renal function, specifically at a glomerular filtration rate (GFR) of 30%, is metformin.
- The reason for discontinuation is the increased risk of lactic acidosis due to metformin accumulation. 2
From the Research
Medications Discontinued with Impaired Renal Function
The following medications are discontinued or have dosage adjustments with impaired renal function, specifically at a glomerular filtration rate (GFR) of 30%:
- Metformin: should be discontinued when eGFR falls below 30 mL/min/1.73m2 3, 4
- Anticancer drugs: dosage adjustment is recommended for drugs with renal clearance equal to or exceeding 30% of the administered dose 5
- Polyethylene glycol (PEG): use is associated with a small risk of renal injury, and caution is advised in patients with pre-existing renal impairment 6
- Acetaminophen: high lifetime use may increase the risk of loss of renal function, and dosage adjustment may be necessary in patients with impaired renal function 7
Key Considerations
- Renal function should be regularly assessed in patients with chronic kidney disease to minimize the risk of medication accumulation 3
- Dosage adjustments should be made based on the patient's individual renal function and the medication's pharmacokinetic properties 5, 3, 4
- Concomitant use of other medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may increase the risk of renal injury 6