Importancia de la hemodiafiltración precoz en el tratamiento de la acidosis láctica asociada a la administración de metformina

metformin is a drug widely used in type 2 diabetic patients. the metformin-associated lactic acidosis (mala) in diabetic patients is rare but can be serious. however, the relationship between metformin and lactic acidosis has been controversial. we present seven cases of patients with alam who came to our centre over a period of one year and who were treated early with haemodiafiltration. there are some risk factors that appear to predispose to this pathology, such as: acute renal failure, hypoxemia and sepsis situations, cardiac or respiratory failure, previous history of lactic acidosis, liver disease and dehydration boxes. that is why their use is discouraged in patients with gfr below 30ml/min/1.73m2. all patients described were treated early with haemodiafiltration. the mortality in our series was 16.6%. we believe that alam is a serious condition that requires prompt diagnosis and early treatment. renal replacement therapy is not the solution for all patients, but can improve prognosis in more severe if started early. we should limit the use of metformin in diabetic patients with impaired renal function, although there is still controversy in the various published studies.