Metformin-associated lactic acidosis(MALA) is a rare but serious adverse effect of the diabetes drug metformin in which the body accumulates too much lactic acid. Investigators developed and tested a protocol for diagnosis and treatment of MALA. Their work will be presented at ASN Kidney Week 2025 November 5– 9.
The protocol, which included immediate initiation of dialysis using either intermittent hemodialysis, continuous kidney replacement therapy, or peritonealdialysis as treatment, was implemented at Maharat Nakhonratchasima hospital (MNRH), in Thailand. Another hospital, Burirum Hospital (BH), did not implementthe protocol. A total of 347 cases were included over 5 years (70 in MNRH pre-intervention, 129 in MNRH intervention, and 148 in BH).
In MNRH, the 30-day mortality rate was reduced from 25.7% to 13.9% afterimplementing the protocol, whereas in BH the 30-day mortality rate was not reduced during the same period (27.2% and 30%). The trend of mortality rate in MNRH during the intervention period decreased by -2.08% per quarter. The average door-to-dialysis time—the interval between a patient's hospital admission and the initiation of dialysis—was reduced from 870 minutes to 690 minutes, and MALA awareness increased from 38.5% to 89.9% after implementation.
"A standardized MALA protocol covering diagnosis, access, and treatment shortened door-to-dialysis time, increased awareness, and reduced care variation," said corresponding author Watanyu Parapiboon, MD, of Maharat Nakhon Ratchasima Hospital, in Thailand. "Fast-track dialysis pathways shouldbe adopted for time-sensitive conditions like MALA. Availability of all dialysis modalities ensures flexibility andenables timely treatment initiation."
Study: "Reducing Mortality in Metformin-Associated Lactic Acidosis (MALA) Through a Fast-Track Clinical Pathway: A Controlled Interrupted Time SeriesQuality Improvement Study"
Join ASN and approximately 12,000 other kidney professionals from across the globe at Kidney Week 2025 in Houston, TX. The world's premier nephrology meeting, Kidney Week, provides participants with exciting and challenging opportunities to exchange knowledge, learn the latest scientific and medical advances, and listen to engaging andprovocative discussions with leading experts in the field. Early programs begin on November 5, followed by the Annual Meeting from November 6-9. Follow the conversation at #KidneyWk.
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