Metformin Can Be Safely Used in Patients Exposed to Contrast Media: A Systematic Review and Meta-Analysis

Abstract

<b><i>Background:</i></b> There have been few studies published on the use of contrast media (CM) in metformin-treated patients. In this study, we conducted a systematic review and meta-analysis to investigate the relationship between metformin and contrast-induced acute kidney injury (CI-AKI). <b><i>Methods:</i></b> A comprehensive search of the Medline, PubMed, Embase, and Web of Science databases for literature on associations between metformin use and CI-AKI incidence was conducted. The pooled odds ratio (<i>OR</i>), or relative risk, as well as the corresponding 95% confidence intervals (<i>CIs</i>), was calculated to assess the relationship between metformin and CI-AKI risk as well as the incidence of lactic acidosis (LA). <b><i>Results:</i></b> In total, seven studies met our eligibility criteria on associations between metformin use and CI-AKI incidence, comprising 2,325 individuals, with 279 new cases of CI-AKI exposed to CM. The pooled analysis revealed no statistically significant increase in the risk of CI-AKI development in patients who used metformin continuously (random-effects <i>OR</i>: 1.15, 95% <i>CI</i>: 0.70–1.90, <i>p</i> = 0.57). No cases of LA that occurred during CM exposure were reported. <b><i>Conclusion:</i></b> Metformin can be safely used in patients with moderate renal impairment (eGFR ≥ 30 mL/min/1.73 m²) during CM exposure.