Metformin-associated lactic acidosis (MALA) poses a significant risk for patients using the diabetes medication metformin, leading to potentially fatal complications. A new intervention protocol aimed at diagnosing and treating MALA has shown promising results in a recent study conducted in Thailand. These findings will be presented at the ASN Kidney Week 2025, scheduled for November 5–9, 2025.
The study involved two hospitals in Thailand: Maharat Nakhon Ratchasima Hospital (MNRH), which implemented the protocol, and Burirum Hospital (BH), which did not. Over a period of five years, researchers examined a total of 347 cases of MALA, with 70 cases at MNRH before the intervention, 129 cases during the intervention, and 148 cases at BH.
After the protocol’s implementation at MNRH, the 30-day mortality rate fell from 25.7% to 13.9%. In contrast, the mortality rate at BH remained relatively unchanged, at 27.2% before the intervention and 30% afterward. This indicates a significant improvement in patient outcomes linked to the new treatment strategy.
The protocol included immediate initiation of dialysis, utilizing methods such as intermittent hemodialysis, continuous kidney replacement therapy, or peritoneal dialysis. The average time from hospital admission to beginning dialysis—known as door-to-dialysis time—decreased from 870 minutes to 690 minutes at MNRH. Additionally, awareness of MALA among healthcare providers surged from 38.5% to 89.9% following the protocol’s implementation.
Dr. Watanyu Parapiboon, the corresponding author of the study and a physician at MNRH, emphasized the importance of standardized protocols in emergency situations. “A standardized MALA protocol covering diagnosis, access, and treatment shortened door-to-dialysis time, increased awareness, and reduced care variation,” he stated. Dr. Parapiboon advocates for fast-track dialysis pathways to ensure timely treatment for conditions like MALA, highlighting the need for the availability of all dialysis modalities to enhance flexibility in patient care.
The successful outcomes observed at MNRH underscore the potential benefits of implementing structured treatment protocols in hospitals facing similar challenges. As MALA remains a critical concern for patients undergoing treatment with metformin, ongoing education and improved clinical practices may further reduce mortality rates associated with this serious condition.
