metformin and dropping egfr

[S_dillow]

i was wondering if any of the t2 diabetics on here had a problem with their numbers dropping while on the drug?i went from 50 to 45 in a weeks time between visits despite all labs normal.curious.

[Bassetmommer NKF Ambassador]

There is a lot of mixed information out there on metformin and CKD. Most ellude to it is not great for CKD. I know for my husband, he was taken off of it and put on Farxiga. His GFR, which continued to decline, went from 3b to almost 2. Metformin is old school and most insurances require that doctors follow a formulary. Which means, metformin first because it is cheap and old school. You have to fail on it, which means either it causes too much distress to the patient, or some side effect. Speak to your Nephrologist to see if you can change it up and try one of the newer, better drugs.

[S_dillow in reply to Bassetmommer]

thanks for the heads up that explains a lot

[jodaer]

I was on metformin for about 20 years, give or take. eGFR stayed pretty good, above 60. But in the last several years, about 5 or so i started to leak more than usual protein and eGFR went down. On Jan it went down to 29 mainly because of the newer test. I was immediately taken off metformin and put on Jardiance them, Trulicity. My latest A1C is now 7.8. I see my endo Friday to discuss what we are going to go with. But I don't think it was the metformin that lowered my eGFR. It did a fantastic job of keeping my diabetes in check. And for the most part my labs are good except for the proteinuria parts.

[S_dillow in reply to jodaer]

hm ok.head scratchin time

[jodaer in reply to S_dillow]

For sure. Almost everything affects the kidneys or the liver. We're danged if we do and danged if we don't. None of the diabetic drugs are recommended. when you get a really low eGFR

[S_dillow]

sheesh.ive got a month to go before i see my nephro.this drops any lower hes gonna hit the ceiling

[jodaer in reply to S_dillow]

let us know what he says

[S_dillow in reply to jodaer]

i will once he cools off.....

[Bassetmommer NKF Ambassador]

Couple of things. First of all, you can have a drop due to dehydration or even a faulty lab. I had that happen to me. The lab somehow got messed up. Supposedly my GFR went down and my potassium was dangerously off the charts. Went to the hospital, this is the same day I had the lab, because they were so concerned about the potassium. They redrew the labs and the GFR went back to where it was and my potassium was fine. It just happens. ( I was very angry though) So maybe your drop will come back up in the next draw. I would do it sooner just to check. AND, secondly, your Nephrologist should not make you feel like you did something wrong when your labs change. I was not sure if you were being funny, but if not, switch the nephrologist. You do not need to add guilt to something you did not do.

[S_dillow in reply to Bassetmommer]

i was only partially kidding he gets ticked at the lab and my pcp not me.

[renegade70 in reply to S_dillow]

he should not do that either. all that does is make you anxious and give you a lack of trust in your health care team. these folks should be working together. if they are in different locations you can usually share electronic medical records between facilities and health care providers. if that does not work you can email the info yourself to your providers. lets face it its your health.

[galesr]

That is the first thing my Nephrologist took me off after a stay in the hospital. He said it harms your kidneys.

[bumblebee_tuna]

I believe Metformin does lower the GFR, but that doesn't necessarily mean that your kidney function is worse. It could just be an artificial decline and your nephrologist will probably want to see the how large is the GFT hit.

For reference ACE inhibitors also lower the GFR initially but are considered renal protective. If Metformin works really well for your diabetes then maybe it makes sense to stay with it, or if not maybe switching to other drugs is more appropriate.

Are you on an SGLT-2 inhibitors? That category of drugs lower your blood sugar and are also renal protective.

[S_dillow in reply to bumblebee_tuna]

no.ihave chf as well so maybe they decided against it?

[bumblebee_tuna in reply to S_dillow]

SGLT-2i are also cardio-protective, these are newish drugs, something to ask you doctor maybe.

[Darlenia]

I have a T2D diabetic hubby who went through all stages and is now has a transplant. Sadly, there really isn't any drug that will roll back that condition. There are many drugs out there and some may be better than others. But I personally think that even though some may make A1Cs look wonderful on paper, it's still best to work with diet and restrict carbs and sugar to avoid those super highs and super lows that happens daily and damages the vessels most everywhere. If you're on metformin (or something similar) you likely have sufficient runway to stave off dialysis. My hubby was on insulin, managed to get off of everything and is back on it now due to the nature of his immunosuppressants. There's a lot of heartache with diabetes, it's a hard journey for many. Praying there will be a cure of this terrible disease someday.

[jodaer in reply to Darlenia]

Totally agree about diet and food and will add exercise. For me all was pretty good as long as i was able to get in a walk every day. Now, since I've not been able to do that, I can tell I'm going downhill. Of course, hitting 80 hasn't helped either. I'm past my expiration date so every day is a blessing.

[Darlenia in reply to jodaer]

You've made it a good long way, Jodaer. Just keep on keeping on! It's been so eye opening to see my hubby's numbers jump so much higher and faster than it does for the general population. He wears a sensor so it's easy to check his numbers anytime - right before eating, right after, etc. It's so sad that metabolism and processing seems to be really different between the two populations. You and all the other lovely people afflicted with it need a cure today, not tomorrow, but today. Seriously.

[jodaer]

And my doctor said it was OK until eGFR went down to 30 I think it was. I don't think anyone really knows and as we're all different no one probably ever will.

[renegade70 in reply to jodaer]

they say that same thing about a lot of medications. they are ok as long as your egfr does not go below 30. that always makes me leery about those particular medications.

[Helloyall]

At that eGFR you need to be on a different type 2 drug and get off the metformin

[Blackknight1989]

Here is what the official literature says of this topic:

he FDA recommends metformin use in patients with T2DM and CKD as follows: (1) Before starting metformin, obtain the patient's eGFR. (2) Metformin is contraindicated in patients with an eGFR <30 mL/min/1.73 m2. (3) Starting metformin in patients with an eGFR between 30 and 45 mL/min/1.73 m2 is not recommended.Feb 21, 2020ncbi.nlm.nih.gov › pmcMetformin Treatment for Patients with Diabetes and Chronic Kidney ...

[S_dillow in reply to Blackknight1989]

uh oh my nephro s not gonna like this if he isnt aware by now....