Occurrence or exacerbation of kidney injury in diabetic patients with urinary tract infections: The context of metformin administration
Juan C. Borrego-Moreno, Aranza Adame-Moreira, Bruno Rivas-Santiago, Carmen J. Serrano
A
BSTRACT
Context and Aims:
Diabetes is characterized by reduced immune function, bladder dysfunction, and glycosuria, risk factors for urinary tract infection (UTI) and subsequent renal complications. This study aimed to identify risk factors associated with the occurrence or exacerbation of kidney injury during a UTI episode in adults with diabetes.
Setting, Design, and Methods:
Analytical observational study involving 154 adults with Type 2 diabetes mellitus who underwent urine culture for UTI. Variables—sociodemographic factors, medical history, comorbidities, diabetes treatment, symptoms, and laboratory profile—were compared between the two groups based on renal function evaluation. Statistical analyses included the Chi-square test and multinomial logistic regression (MLR) to identify variables independently associated with renal injury.
Results:
Three outcomes were identified: exacerbation of renal failure, de novo acute kidney injury (AKI), and no AKI. Elevated urea and creatinine levels were highly prevalent in the exacerbation group (86% and 97%, respectively). Anemia was also more common in the exacerbation group (54.4%). Conversely, AKI often presented with nonspecific symptoms like malaise (35.3%) and diagnoses of ascending infections. The MLRA revealed that metformin use increased the risk of kidney failure exacerbation (OR: 2.33). Elevated creatinine levels were the strongest predictor of exacerbation, reducing the likelihood of being in the no AKI group (OR = 0.11).
Conclusions:
Chronic kidney disease (CKD), elevated creatinine, and metformin identify a subgroup at high risk of renal exacerbation. Our findings suggest discontinuing or avoiding metformin administration in patients with a history of CKD during a UTI episode.