Metformin and Post-Contrast Acute Kidney Injury - literature review

Introduction and Purpose. Modern diagnostic medicine is characterized by a steady upward trend in the utilization of contrast-enhanced imaging procedures, which directly elevates the population-wide risk of post-contrast acute kidney injury (PC-AKI). In the context of the rising prevalence of type 2 diabetes, a significant cohort of patients undergoing these examinations receives chronic metformin therapy. Although this agent does not exhibit direct nephrotoxicity, its systemic accumulation in the setting of PC-AKI can precipitate lactic acidosis—a rare but highly lethal metabolic complication [1]. This study aims to provide a critical analysis of current data regarding the risks associated with metformin use during radiological procedures and to evaluate contemporary clinical guidelines for the safe management of this patient population. Materials and methods. A review was conducted using PubMed, Google Schoolar and ResearchGate. Search terms included: metformin, biguianids, AKI, PC-AKI, acute kidney injury, contrast, lactic acidosis, prevention, contrast-induced-nephropathy. Studies and clinical guidelines published between 2006 and 2025. Results. This review corroborates that while metformin itself does not possess inherent nephrotoxic properties, its systemic presence during an episode of PC-AKI exacerbates the risk of life-threatening lactic acidosis. Our analysis underscores the necessity of a patient-centered approach, prioritized by the assessment of baseline renal function, rather than the implementation of rigid, universal protocols for metformin discontinuation across the entire patient population. Conclusion. "Consequently, current clinical guidelines prioritize the assessment of creatinine clearance and the early identification of renal impairment during diagnostic imaging. Adherence to these protocols ensures patient safety during radiological interventions while effectively mitigating the risk of severe metabolic adverse events."