A recent study indicates that a new intervention protocol may significantly reduce mortality associated with metformin-associated lactic acidosis (MALA), a rare but serious complication of the diabetes medication metformin. Researchers implemented a comprehensive approach for diagnosing and treating MALA at Maharat Nakhon Ratchasima Hospital (MNRH) in Thailand, with promising results that will be presented at the upcoming ASN Kidney Week 2025, scheduled for November 5–9.
The protocol included immediate initiation of dialysis, utilizing various methods such as intermittent hemodialysis, continuous kidney replacement therapy, or peritoneal dialysis. Over a five-year period, the study analyzed a total of 347 cases: 70 at MNRH prior to the intervention, 129 during the intervention, and 148 at Burirum Hospital (BH), which did not adopt the new protocol.
After the implementation at MNRH, the 30-day mortality rate dropped from 25.7% to 13.9%. In contrast, BH experienced no decrease in its 30-day mortality rate, which remained consistent at 27.2% and 30% during the same period. The trend at MNRH also revealed a significant decline in mortality rates, decreasing by -2.08% per quarter throughout the intervention.
Improved Response Times and Awareness
The study also highlighted improvements in the average door-to-dialysis time, which decreased from 870 minutes to 690 minutes following the protocol implementation. Additionally, awareness of MALA among healthcare providers surged from 38.5% to 89.9%.
Dr. Watanyu Parapiboon, the corresponding author from MNRH, emphasized the importance of the standardized protocol, stating, “A standardized MALA protocol covering diagnosis, access, and treatment shortened door-to-dialysis time, increased awareness, and reduced care variation.” He further advocated for the adoption of fast-track dialysis pathways for conditions like MALA, stressing that the availability of all dialysis modalities ensures flexibility and facilitates timely treatment initiation.
The findings from this study present a crucial advancement in managing MALA, potentially saving lives through enhanced awareness and quicker treatment protocols. As healthcare providers continue to address the challenges posed by diabetes medications, this intervention may serve as a model for other institutions aiming to improve patient outcomes in similar critical situations.
