Oleh Admin Kalbe Medical pada July 09, 2018 06:00

Penggunaan Obat Metformin pada Diabetesi dengan CKD, Amankah?

Selama ini klinisi menghindari pemberian metformin pada pasien diabetes (diabetesi) dengan penyakit ginjal kronik/CKD (chronic kidney disease), karena risiko asidosis laktat yang berpotensi muncul. Dalam analisis terhadap 2 studi retrospektif skala besar di Amerika Serikat menunjukkan bukti bahwa tidak ada kaitan yang signifikan antara terapi metformin dan insidens asidosis laktat dengan laju filtrasi glomerulus terhitung (eGFR/estimated glomerulus filtration rate) sekurang-kurangnya 30 mL/min/1,73 m2 (kategori CKD derajat berat atau stage 4). Angka asidosis pada pengguna metformin dengan GFR rentang 30-44 atau 45-59 mL/min/1,73 m2 adalah sebanding dengan mereka yang tidak pernah diberikan metformin.

Secara ringkas, studi kohort tersebut melibatkan 75.413 pasien diabetes dari bulan Januari 2004-Januari 2011. Selama median follow up 5,7 tahun, terdapat 2335 perawatan di rumah sakit akibat asidosis. Peneliti kemudian mereplikasikan hasil ini pada kohort kedua yang melibatkan 67.578 pengguna baru metformin dan 14.439 pengguna sulphonylurea baru antara tahun 2010-2015.

Setelah dibandingkan dengan terapi diabetes alternatif lain, analisis menunjukkan bahwa penggunaan metformin yang berbatas waktu tidak terkait dengan insidens asidosis keseluruhan (adjusted hazard ratio [HR], 0,98). Hal tersebut juga tidak terkait dengan insidens asidosis pada pasien dengan eGFR 45-59 mL/min/1.73 m2 (adjusted HR, 1,16) dan eGFR 30-44 mL/min/1.73 m2 (adjusted HR, 1,09). Peningkatan terjadinya asidosis terlihat pada penggunaan metformin pada eGFR kurang dari 30 mL/min/1,73 m2 (adjusted HR, 2,07).

Dilihat dari perjalanan panjang metformin dalam tatalaksana penyakit diabetes tipe 2, metformin telah diunggulkan cukup lama sebagai terapi lini pertama namun penggunaannya dikontraindikasikan pada pasien CKD, sampai akhirnya di tahun 2016 FDA mengijinkan pemberian metformin dengan CKD ringan (eGFR, 45 mL/min/1,73 m2 atau lebih). Namun jika eGFR turun pada rentang 30-45, yang merupakan kriteria CKD sedang, maka FDA merekomendasikan pemberian secara lebih hati-hati dengan memperhitungkan dengan hati-hati risiko/keuntungan sebelum akhirnya memutuskan untuk melanjutkan atau menghentikan terapi. Metformin tetap dikontraindikasikan pada CKD berat (eGFR <30 mL/min/1,73 m2).

Simpulan:
Dengan hasil tersebut, maka semakin mendukung meluasnya penggunaan metformin dalam kaitannya dengan seberapa berat CKD yang diderita pasien. Metformin dapat diberikan pada GFR di rentang 45-59 dan diberikan secara hati-hati pada GR 30-44 mL/min/1,73 m2, dan hal ini pun telah disetujui oleh FDA. (PMD)

Image : Ilustrasi
Referensi:
Jenkins K. Evidence growing metformin safe in many with diabetes and CKD [Internet]. 2018 [cited 2018 June 7]. Available from: https://www.medscape.com/viewarticle/897647.

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