Metformin in non-diabetic patients with autosomal dominant polycystic kidney disease: a systematic review and meta-analysis of randomized controlled trials
Abstract
INTRODUCTION: Autosomal dominant polycystic kidney disease (ADPKD), which is caused mainly by mutations in the PKD1 or PKD2 genes, is a genetic disorder characterized by the growth of cysts and decreased kidney function. There is limited evidence on pharmacological interventions capable of slowing down disease progression in non-diabetic patients. Metformin, widely used to treat type 2 diabetes, has shown potential nephroprotective effects through activation of AMPK and inhibition of the mTOR pathway. METHODS: PubMed, Embase and Cochrane databases were searched for randomized clinical trials (RCTs) comparing metformin versus placebo or standard care in non-diabetic patients with ADPKD. Standardized mean differences (SMDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated via random-effects model. Heterogeneity was assessed using the I2 test. Statistical analyses were performed using Review Manager, version 5.4, and R Software, version 4.4.2. RESULTS: Four RCTs were included, comprising 213 patients. Average follow-up ranged from 0.15 to 2 years. No significant differences were observed in the decline of kidney function (SMD: 0.19; 95% CI, −0.08 to 0.46; p = 0.17) or in height-adjusted total kidney volume (htTKV) progression (SMD: 0.09; 95% CI, −0.20 to 0.38; p = 0.53). Gastrointestinal adverse events were more frequent in the metformin group (RR: 2.93; 95% CI, 1.51 to 5.67; p = 0.0014), while the incidence of hypoglycemia did not differ between groups…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 213 participants or records.
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