Table 2.

Selected guidelines and recommendations regarding metformin use and kidney function

Source, year (reference)	Guidelines and recommendation regarding metformin use
FDA, 1994 (26)	• Contraindicated if creatinine of ≥1.4 mg/dL (men) or ≥1.5 mg/dL (women)
National Kidney Foundation Kidney Disease Outcomes Quality Initiative, 2012 (15)	• Contraindicated if creatinine of ≥1.4 mg/dL (men) or ≥1.5 mg/dL (women)
National Institute for Health and Clinical Excellence, 2009 (27)	• To be reviewed if creatinine >1.5 mg/dL or eGFR <45 mL/min/1.73 m2 • Contraindicated if creatinine >1.7 mg/dL or eGFR <30 mL/min/1.73 m2
American Diabetes Association and European Association for Study of Diabetes, 2012 (28)	• Dose reduction if eGFR <45 mL/min/1.73 m2 • Contraindicated if eGFR <30 mL/min/1.73 m2
Kidney Disease: Improving Global Outcomes, 2012 (29)	• To be reviewed if eGFR 30–45 mL/min/1.73 m2 • Contraindicated if eGFR <30 mL/min/1.73 m2 • Temporarily held if eGFR <60 mL/min/1.73 m2 with a concurrent serious illness increasing the risk of AKI
Canadian Diabetes Association, 2013 (30)	• Cautioned if eGFR <60 mL/min/1.73 m2 • Contraindicated if eGFR <30 mL/min/1.73 m2
Royal Australian College of General Practitioners, 2014–2015 (31)	• Cautioned and dose reduction advised if eGFR 30–45 mL/min/1.73 m2 • Contraindicated if eGFR <30 mL/min/1.73 m2
Japanese Society of Nephrology, 2012 (32)	• Reevaluated if eGFR <45 mL/min/1.73 m2 • Contraindicated if eGFR <30 mL/min/1.73 m2
Opinion of the authors	• To be reviewed if eGFR 45–60 mL/min/1.73 m2 or any eGFR with prior episodes of AKI or significant proteinuria >0.5 g/day that may predispose to AKI • Contraindicated if eGFR <45 mL/min/1.73 m2, if creatinine ≥1.4 mg/dL (men) or ≥1.5 mg/dL (women), or if cystatin C >1.2 mg/mL • Withhold at any eGFR if high likelihood of AKI, such as IV contrast administration

Adapted with permission from Rhee and Kalantar-Zadeh (6).