Renal Failure & Lactic Acidosis in Diabetic Woman Receiving Metformin,Rofecoxib

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Renal Failure & Lactic Acidosis in Diabetic Woman Receiving Metformin,Rofecoxib

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Acute Renal Failure and Lactic Acidosis Reported in Diabetic Woman

Receiving Metformin and Rofecoxib

British Journal of Anaesthesia

By Keely S. , PhD

Doctors report that rofecoxib, a COX 2 inhibitor, may have

contributed to a case of acute renal failure and metformin-related

lactic acidosis.

COX 2 inhibitors are becoming increasingly popular for treatment of

inflammatory conditions due to a reduced incidence of

gastrointestinal side effects compared with traditional non-steroidal

anti-inflammatory drugs (NSAIDS).

" What is less well appreciated is the role that the COX 2 inhibitors

may play in the development of renal failure, " writes Grant Price, of

Hospital, Kirkcaldy, Fife, Scotland.

In the case report, Dr. Price describes a 58-year-old woman diagnosed

with acute renal failure and lactic acidosis. The patient had a

medical history that included 10 years of type 2 diabetes mellitus

treated with diet modification and metformin.

According to Dr. Price, metformin therapy leads to an increase in

lactic acid production, and type B lactic acidosis has been

documented as a rare complication of this treatment. Moreover, any

renal impairment results in a reduced clearance of lactic acid, which

can increase the risk for lactic acidosis in patients receiving

metformin.

The cause of renal failure was not apparent after examination of the

patient, and her most recent pre-morbid biochemical profile revealed

normal renal function 2 months before admission. However, rofecoxib

therapy had been started for arthritis pain 1 month prior to

admission. This treatment may have been the precipitating factor for

the renal failure, which may have subsequently triggered lactic

acidosis because of metformin therapy, Dr. Price writes.

In support of this idea, he notes that nephrotoxicity is a well-

described complication of traditional NSAID therapy. Large trials

with COX 2 inhibitors have focused mainly on gastric safety profiles

rather than renal safety, but more recent studies have suggested that

this new class may lead to a pattern of nephrotoxicity similar to the

traditional non-selective NSAIDS.

" The COX 2 inhibitors may have an improved side-effect profile with

regard to gastric side effects, but their renal safety profile has

not been established, " cautions Dr. Price.

Based on the evidence from this case, he suggests that COX 2

inhibitors " can lead to a potentially disastrous outcome " in patients

receiving metformin.

Br J Anaesth 2003 Dec;91:6:909-10.