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Human studies of patients with diabetes mellitus (DM) regarding the association of metformin use with end\u2010stage renal disease (ESRD) are lacking. Patients with type 2 DM and without a history of kidney disease who were enrolled under the pay\u2010for\u2010performance program of the National Health Insurance in Taiwan were identified. Those who received \u226590 cumulative defined daily doses of metformin within 1 year were selected (metformin users) and compared with a 1:1 propensity score\u2013matched metformin nonuser cohort. Primary and secondary outcomes were development of ESRD and chronic kidney disease (CKD), respectively. Independent predictors were investigated using Cox regression analysis. A total of 24\u00a0158 pairs of metformin users and nonusers were enrolled, with an incidence of ESRD of 1908 and 1723 and CKD of 1095 and 1056 cases per 100\u00a0000 person\u2010years, respectively. Metformin use was independently associated with increased risks of ESRD (adjusted hazard ratio, 1.22; 95% confidence interval, 1.12\u20101.32) and CKD (adjusted hazard ratio, 1.25; 95% confidence interval, 1.12\u20101.40) in a dose\u2010response relationship. Patients with hypertension plus nonuse of angiotensin\u2010converting enzyme inhibitors or angiotensin II receptor blockers potentiated kidney damage by metformin. In patients with DM, use of metformin may increase the risk of ESRD and CKD. Health care professionals should be alert and closely monitor renal function when prescribing metformin.<\/jats:p>","DOI":"10.1002\/jcph.1452","type":"journal-article","created":{"date-parts":[[2019,6,4]],"date-time":"2019-06-04T18:53:08Z","timestamp":1559674388000},"page":"1443-1452","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Association of Metformin Use With End\u2010Stage Renal Disease in Patients With Type 2 Diabetes Mellitus: A Nationwide Cohort Study Under the Pay\u2010for\u2010Performance Program"],"prefix":"10.1002","volume":"59","author":[{"given":"Ming\u2010Chia","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Pharmacy New Taipei City Hospital  New Taipei City Taiwan"},{"name":"School of Pharmacy College of Pharmacy Taipei Medical University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chih\u2010Hsin","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Medicine Department of Internal Medicine Wan Fang Hospital Taipei Medical University  Taipei Taiwan"},{"name":"Division of Pulmonary Medicine Department of Internal Medicine School of Medicine College of Medicine Taipei Medical University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lih\u2010Yu","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine National Taiwan University Hospital  Hsin\u2010Chu Branch Hsin\u2010Chu Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia\u2010Hao","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine National Taiwan University Hospital  Hsin\u2010Chu Branch Hsin\u2010Chu Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun\u2010Fu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine National Taiwan University Hospital  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng\u2010Rui","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine National Taiwan University Hospital  Hsin\u2010Chu Branch Hsin\u2010Chu Taiwan"},{"name":"Department of Internal Medicine National Taiwan University Hospital  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3406-366X","authenticated-orcid":false,"given":"Jann\u2010Yuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine National Taiwan University Hospital  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih\u2010Ming","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Pharmacy College of Pharmacy Taipei Medical University  Taipei Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,6,4]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"IDF Diabetes Atlas.8th ed. 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