Diabetes Status Does Not Affect Blook Lactic Acid in Elderly Veterans with Stage 3 Chronic Kidney Disease
Sheikh Raza Shahzad1, Elvira O. Gosmanova2, Aidar R. Gosmanov3. 1Medicine, Albany Medical College/Albany VAMC, Albany, New York, United States, 2Nephrology, Albany Medical College/Albany VAMC, Albany, New York, United States, 3Endocrinology, Albany Medical College/Albany VAMC, Albany, New York, United States
Purpose of Study Metformin use in type 2 diabetes (T2D) is associated with an increased risk of lactic acidosis. Recent FDA guidance broadened metformin use in T2D to the patients with chronic kidney disease stage 3 (CKD3). It is unknown if diabetic patients with CKD3 not treated with metformin have increased baseline level of lactic acid (LA) compared with non-diabetic CKD3 patients. The aim of our study was to characterize LA level in CKD3 patients treated with and without T2D.
Methods Used We retrospectively identified elderly male US Veterans (age >60 years) with T2D and stable CKD3 (eGFR 30-59 ml/min/1.73m2). The blood LA levels were analyzed in ambulatory patients with non-diabetic CKD3 (Group 1) and diabetic CKD3 (Group 2). Hyperlactatemia was defined as LA 2-4 mmol/L. Patients treated with metformin or with history of HIV, advanced CHF, alcohol abuse, and liver cirrhosis were excluded. Clinical and biochemical characteristics and LA level among groups were analyzed using Student's t-tests and Fisher's exact tests.
Summary of Results Mean LA levels (normal range 0.4-2.0 mmol/L) were similar between Group 1 (N=29, age 71.4±10.2years, BMI 29.8±4.5kg/m2, HbA1c 5.6±0.3%) and Group 2 (N=31, age 73.0±7.4years, BMI 32.3±5.7kg/m2, HbA1c 7.5±1.3%) at 1.24±0.34 vs 1.29±0.42 mmol/L (P=0.65), respectively. Only 1 patient in each Group had hyperlactatemia detected during routine clinic visit. There was no significant difference in the mean LA level within the Group 1 patients with CKD stage 3A (eGFR 45-59 ml/min/1.73m2, N=12, LA 1.23±0.26 mmol/L) and CKD stage 3B patients (eGFR 30-44 ml/min/1.73m2, N=17, LA 1.21±0.43 mmol/L). Similarly, we found no differences in LA level between Group 2 patients with CKD stage 3A (N=15, mean LA 1.31±0.39mmol/L) and CKD stage 3B (N=16, mean LA 1.28±0.45mmol/L).
Conclusions Elderly T2D patients with CKD stage 3 not treated with metformin have baseline lactic acid level that is similar to non-diabetic patients with CKD stage 3. The risk of spontaneous hyperlactatemia in these patients is very low.
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