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Metformin: The Forgotten Agent

  • 1 Clarissa Jonas Diamantidis, MD, is a nephrologist affiliated with Duke University School of Medicine.
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Effective, safe glycemic control is a global priority because uncontrolled diabetes contributes to a substantial burden of morbidity and mortality related to chronic kidney disease (CKD), ESKD, and cardiovascular disease (CVD) (1, 2). However, achieving this goal in patients with advanced kidney disease is complicated by evolving safety recommendations and contraindications to several existing antihyperglycemic medications when kidney function is substantially impaired (2). Amid robust evidence for inhibition of the renin-angiotensin system as the mainstay of managing diabetic kidney disease and growing attention to the significant cardiovascular, kidney, and survival benefits of sodium glucose