PMID- 30218617
OWN - NLM
STAT- MEDLINE
DCOM- 20190705
LR  - 20200725
IS  - 1742-7843 (Electronic)
IS  - 1742-7835 (Print)
IS  - 1742-7835 (Linking)
VI  - 124
IP  - 3
DP  - 2019 Mar
TI  - Cystatin C measurement leads to lower metformin dosage in elderly type 2 diabetic 
      patients.
PG  - 298-302
LID - 10.1111/bcpt.13132 [doi]
AB  - The aim of this study was to provide evidence for the hypothesis that estimated 
      glomerular filtration rate from serum Cystatin C (eGFRcys) is better to be 
      determined for all elderly type 2 diabetes mellitus (T2DM) patients based on 
      eGFRcys upward and downward reclassification rate for hypothetical metformin dose 
      reduction by eGFRcys at the GFR decision point of 45 mL/min/1.73 m(2) . A total 
      of 265 consecutive T2DM elderly patients (age range 65-91 years) from outpatient 
      diabetic clinic were included in the study. The Kidney Disease Improving Global 
      Outcomes (KDIGO) guidelines for metformin dosing were strictly followed. 
      Estimated glomerular filtration rate from serum creatinine (eGFRcrea) led to 
      results of metformin eligibility. Each of the results of eGFRcrea-based 
      eligibility was further compared to eGFRcys-based eligibility. Creatinine was 
      measured by enzymatic method standardized against international reference 
      material SRM 967. Cystatin C was determined by method traceable to DA ERM 471 
      international standard. eGFRcrea and eGFRcys were calculated according to Chronic 
      Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. A downward 
      reclassification rate was higher than upward reclassification rate (31 vs 3, 
      respectively; P < 0.0001). The median (IQR) eGFRcrea was higher than eGFRcys (73 
      (58-85) vs 63 (50-75) mL/min/1.73 m(2) , respectively; P < 0.0001). eGFRcys 
      reclassified significant proportion of patients with T2DM from metformin eligible 
      CKD stages to less or non-eligible stages. The downward reclassification was more 
      frequent in patients older than 80 years (P < 0.01). Cystatin C-based eGFR 
      selects more complicated patients, where lower doses of metformin are possibly 
      advisable. We recommend calculating both eGFRcrea and eGFRcys for metformin 
      dosing in elderly patients with T2DM.
CI  - (c) 2018 Nordic Association for the Publication of BCPT (former Nordic 
      Pharmacological Society).
FAU - Salek, Tomas
AU  - Salek T
AD  - Department of Clinical Biochemistry and Pharmacology, Tomas Bata Hospital in Zlin 
      a. s., Zlin, Czech Republic.
AD  - Department of Biomedical sciences, Medical Faculty, University of Ostrava, 
      Ostrava, Zabreh, Czech Republic.
FAU - Adamikova, Alena
AU  - Adamikova A
AD  - Diabetes Center, Tomas Bata Hospital in Zlin, a. s., Zlin, Czech Republic.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20181017
PL  - England
TA  - Basic Clin Pharmacol Toxicol
JT  - Basic & clinical pharmacology & toxicology
JID - 101208422
RN  - 0 (Cystatin C)
RN  - 0 (Hypoglycemic Agents)
RN  - 9100L32L2N (Metformin)
RN  - AYI8EX34EU (Creatinine)
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Creatinine/blood
MH  - Cystatin C/*blood
MH  - Diabetes Mellitus, Type 2/*blood/*drug therapy/physiopathology
MH  - Dose-Response Relationship, Drug
MH  - Glomerular Filtration Rate/physiology
MH  - Humans
MH  - Hypoglycemic Agents/administration & dosage
MH  - Metformin/*administration & dosage
MH  - Renal Insufficiency, Chronic/blood/physiopathology
MH  - Retrospective Studies
PMC - PMC7379635
OTO - NOTNLM
OT  - creatinine
OT  - cystatin C
OT  - estimated glomerular filtration rate
OT  - glomerular filtration
OT  - metformin
COIS- None declared.
EDAT- 2018/09/16 06:00
MHDA- 2019/07/06 06:00
PMCR- 2020/07/24
CRDT- 2018/09/16 06:00
PHST- 2018/08/27 00:00 [received]
PHST- 2018/09/10 00:00 [accepted]
PHST- 2018/09/16 06:00 [pubmed]
PHST- 2019/07/06 06:00 [medline]
PHST- 2018/09/16 06:00 [entrez]
PHST- 2020/07/24 00:00 [pmc-release]
AID - BCPT13132 [pii]
AID - 10.1111/bcpt.13132 [doi]
PST - ppublish
SO  - Basic Clin Pharmacol Toxicol. 2019 Mar;124(3):298-302. doi: 10.1111/bcpt.13132. 
      Epub 2018 Oct 17.