Metformin in Diabetic Kidney Disease Immediate release: • Initial 500 mg or 850 mg once daily • Titrate upwards by 50 mg/d or 850 mg/d every 7 days until maximum dose eGFR 30-44: Initiate at half the dose and titrate upwards to half of maximum recommended dose eGFR < 30: Stop metformin; do not initiate metformin Monitor vitamin B12 annually if on metformin for more than 4 years or at risk of vitamin B12 deficiency Monitor kidney function at least every 3-6 months #Metformin #CKD #pharmacology #algorithm #management #kdigo #initiation #titration
