A new intervention protocol has shown promise in reducing mortality rates associated with metformin-associated lactic acidosis (MALA), a serious complication of the diabetes medication metformin. Research conducted at Maharat Nakhon Ratchasima Hospital (MNRH) in Thailand will be presented at the ASN Kidney Week 2025, scheduled for November 5–9.
The protocol involved immediate initiation of dialysis, utilizing options such as intermittent hemodialysis, continuous kidney replacement therapy, or peritoneal dialysis for treatment. In contrast, Burirum Hospital (BH), which did not implement the protocol, served as a comparison site. Over five years, investigators included a total of 347 cases in their study, with 70 cases at MNRH before the intervention, 129 cases during the intervention, and 148 cases at BH.
Following the implementation of the protocol at MNRH, the 30-day mortality rate decreased significantly from 25.7% to 13.9%. In comparison, BH recorded a mortality rate that remained relatively unchanged at 27.2% before the intervention and 30% during the same timeframe. Notably, the trend in mortality rate at MNRH during the intervention period showed a decrease of -2.08% per quarter.
The research revealed a marked improvement in the average door-to-dialysis time, which was reduced from 870 minutes to 690 minutes at MNRH post-implementation. Additionally, awareness of MALA among healthcare providers increased dramatically, rising from 38.5% to 89.9% after the protocol was introduced.
Dr. Watanyu Parapiboon, the corresponding author and a physician at MNRH, emphasized the impact of a standardized protocol. “A standardized MALA protocol covering diagnosis, access, and treatment shortened door-to-dialysis time, increased awareness, and reduced care variation,” he stated. He further advocated for the establishment of fast-track dialysis pathways for time-sensitive conditions such as MALA, arguing that the availability of various dialysis modalities enhances flexibility and enables timely treatment initiation.
The findings underscore the importance of structured protocols in managing critical medical conditions and their potential to save lives. As MALA remains a rare but serious complication for patients on metformin, the research highlights the need for heightened awareness and rapid response in clinical settings.
As this protocol is discussed at ASN Kidney Week 2025, its implications for improving patient outcomes in similar healthcare contexts may resonate well beyond Thailand.
