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"textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with interest the article by Boada Fernández del Campo et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> on metformin-associated lactic acidosis (MALA), where the authors performed an excellent analysis on its association with acute renal dysfunction, highlighting the creatinine levels detected in patients admitted with MALA. However, the authors did not analyze the previous renal dysfunction of the patients with metformin and hyperlactatemia, which is clearly related to this sometimes fatal complication.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In a retrospective observational study from January 2016 to June 2018 in Hospital San Juan de Dios del Aljarafe, a district hospital that treats 294,000 inhabitants, with a rate of metformin use of 430/10,000 inhabitants/year, we analyzed 9283 emergency episodes of patients treated with metformin (10.6 emergency episodes/month/10,000 inhabitants). We detected 222 cases with lactate levels ≥2.7 mmol/L. In 56 cases, hyperlactatemia was associated with acidosis and renal failure, 17 of the which (30%) were diagnosed with MALA (5.4 cases/10,000 patients with metformin/year, similar to the study by Boada Fernández del Campo et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>). Of these, 10 were admitted to the ICU requiring dialysis,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> with an overall mortality of 53%. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> lists the baseline glomerular filtration rates (GFR) of the treated patients, showing that 35% of those who presented hyperlactatemia, 53% of those with associated renal dysfunction and acidosis, and 76% of those who developed MALA had previous renal dysfunction.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">We observed that the incidence rate of hyperlactatemia in both studies was higher than that reported in the datasheet (<1:10,000 exposed individuals) and that reported in other studies.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Our study data also confirm that a high proportion of the patients with metformin-associated hyperlactatemia had a baseline GFR <60 mL/min/1.73 m<span class="elsevierStyleSup">2</span>. Given the high associated mortality, we believe that precautions need to be taken in handling metformin in patients with renal dysfunction.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p></span>"
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"nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Blanco Taboada AL, et al. Acidosis láctica por metformina: ¿debemos ser más cautelosos con la disfunción renal? Rev Clin Esp. 2020;220:76–76.</p>"
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"leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">GFR, glomerular filtration rate estimated by the modification of diet in renal disease-4 formula; MALA, metformin-associated lactic acidosis.</p>"
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<table border="0" frame="\n
\t\t\t\t\tvoid\n
\t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n
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\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients with hyperlactatemia (n = 222) \t\t\t\t\t\t\n
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\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
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\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients with hyperlactatemia, acidosis and renal failure (n = 56) \t\t\t\t\t\t\n
\t\t\t\t\t\t</th><th class="td" title="\n
\t\t\t\t\ttable-head\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients with MALA (n = 17) \t\t\t\t\t\t\n
\t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Baseline GFR <30 mL/min/1.73 m<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
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\t\t\t\t">11 (5%) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
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\t\t\t\t">6 (11%) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">2 (11%) \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Baseline GFR 30–60 mL/min/1.73 m<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
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\t\t\t\t">66 (30%) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">23 (42%) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">11 (65%) \t\t\t\t\t\t\n
\t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">Baseline GFR >60 mL/min/1.73 m<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
\t\t\t\t\ttop\n
\t\t\t\t">145 (65%) \t\t\t\t\t\t\n
\t\t\t\t</td><td class="td" title="\n
\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
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\t\t\t\t">27 (47%) \t\t\t\t\t\t\n
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\t\t\t\t\ttable-entry\n
\t\t\t\t " align="left" valign="\n
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\t\t\t\t">4 (24%) \t\t\t\t\t\t\n
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