Rohollah Masumi
1, Ramin Tolouian
2 
, Audrey Tolouian
3 , Leila Mohmoodnia
1* 1 Cancer Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
2 Division of Nephrology, University of Arizona, Tucson, AZ, USA
3 School of Nursing, University of Texas, El Paso, TX, USA
Abstract
Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a disorder of mineral and bone metabolism due to chronic kidney disease (CKD). Bone disease and mortality are more common in patients with CKD. In addition of antidiabetic properties of metformin (MET), it possesses anti-inflammatory, anti-fibrotic properties and increases the markers of osteogenic effects. Therefore, it improves bone quality and decreases the risk of fractures in patients with type 2 diabetes. Metformin can also inhibit arterial calcification, maintain calcium-phosphorus balance, decrease cellular infiltration, fibrosis, and inflammation in kidney. Based on evidence, the prevalence of lactic acidosis due to metformin in patients with type 2 diabetes (T2D) and renal dysfunction is lower compared to other oral antidiabetic agents. Metformin decreases all-cause mortality in patients with diabetic nephropathy. The administration of metformin showed no difference in the prevalence of lactic acidosis in patients with T2D who had normal, mild, moderate, or severe renal dysfunction. Therefore, metformin can be used in patients with significant CKD to inhibit CKD-MBD due to its osteogenic effects.
Implication for health policy/practice/research/medical education:
Metformin can be used in patients with significant chronic kidney disease, while inhibiting CKD-MBD (chronic kidney disease-mineral and bone disorder) due to its osteogenic effects.
Please cite this paper as: Masumi R, Tolouian R, Tolouian A, Mohmoodnia L. The impact of metformin in chronic kidney disease-mineral and bone disorder. J Nephropharmacol. 2021;10(1):e02. DOI: 10.34172/npj.2021.02.