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CPE-003 · synthetic case CKD-FX-012
Metformin contraindication threshold
Metformin contraindication threshold
Purpose: Apply FDA renal impairment safety logic
Inputs the engine received
Patient
- Age
- 73 years
Context
- Sex for equation
- female
- Medication active
- metformin
Laboratory
- Serum creatinine
- 2.1 mg/dL
What the engine reports
Metformin labeling contraindicates use below eGFR 30 mL/min/1.73 m². Clinician medication review required.
Detected clinical pattern
Kidney Abnormality Detected — CKD Not Confirmed
A single abnormal result does not establish CKD. Persistence over at least three months and exclusion of acute or transient causes are needed.
- Chronicity: Chronicity unconfirmed
- CGA: Indicative G4A? (not a classification)
Clinical summary
A kidney abnormality was detected (eGFR 24.4), but chronicity is not established; CKD is not confirmed. Priority: confirm persistence and exclude acute or transient causes.
Why this pattern was identified
- Estimated GFR. 24.4 mL/min/1.73 m² (eGFRcr 2021, race-free), category G4 (15–29).
Calculations
- eGFRcr (CKD-EPI 2021, race-free)
- 24.4 mL/min/1.73 m²
Creatinine-based.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Clinician medication review of metformin against current FDA labeling.
- 2Confirm persistence (repeat testing at ≥3 months) and evaluate acute or transient causes before labeling CKD.A single abnormal eGFR or UACR does not establish CKD.
- 3Specialist kidney-care referral per triggered criterion: eGFR <30.KDIGO 2024 referral criteria.
Missing information
- UACR (required for the A category, risk assessment and a complete classification).
Why it matters
Isolated abnormal eGFR or UACR values are common and often transient. Labeling CKD early can misclassify patients, while missing persistent disease delays care. Confirmation at three months balances both.
Evidence and rule trace · 6 rules
DQ-004eGFR calculation assay provenance
Inputs: creatinine assay IDMS traceability not confirmed
eGFR computed with unknown/non-confirmed standardized assay; interpret with assay provenance visible.
GFR-001Compute initial adult race-free creatinine eGFR
Inputs: creatinine 2.1 mg/dL · age 73 · sex female
eGFRcr 2021 = 24.4 mL/min/1.73 m²
DET-001Kidney abnormality detected
Inputs: eGFR 24.4 (<60)
kidney_abnormality_detected: determine chronicity and evaluate acute causes before confirming CKD
CHR-003Single abnormal result does not confirm CKD
Inputs: abnormality without dated evidence of ≥3 months
kidney_abnormality_unconfirmed: CKD is not confirmed
MED-MET-001Metformin renal impairment labeling flag
Inputs: eGFR 24.4 (<30) · metformin active
metformin labeling contraindicates use below eGFR 30: clinician medication review required
REF-001Nephrology referral triggers
Inputs: eGFR <30
Specialist kidney care referral indicated or to be considered per the triggered criterion
Evidence
- R1 · KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Disease: Improving Global Outcomes (KDIGO), 2024.
- R3 · eGFR Equations for Adults: 2021 CKD-EPI creatinine and creatinine-cystatin C race-free equations. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) / NIH, 2026.
- R4 · NKF/ASN recommendations implementing race-free CKD-EPI equations. National Kidney Foundation / American Society of Nephrology, 2021.
- R8 · GLUCOPHAGE / GLUCOPHAGE XR Prescribing Information - Renal Impairment Recommendations. U.S. Food and Drug Administration (FDA) - Drugs@FDA labeling, 2017.
Physician adjudication required. Clinical decision support for physician review. Criteria-based status is not a probability. Findings require physician adjudication and correlation with the complete clinical context. Validation-only release: not for production clinical use.
Change the values
The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.
Live eGFR and CGA map
eGFR (mL/min/1.73 m²)
24.4
CKD-EPI 2021 creatinine, race-free
| GFR \ ALB | A1<30 | A230–300 | A3>300 |
|---|---|---|---|
| G1≥90 | |||
| G260–89 | |||
| G3a45–59 | |||
| G3b30–44 | |||
| G415–29 | |||
| G5<15 |
Indicative cell G4A? only: CKD is not confirmed, so this is not a classification. Colors follow the KDIGO risk heat map: green low, yellow moderately increased, orange high, red very high.
Kidney functionAdd a prior result with dates to test chronicity
Switches the engine to the combined eGFRcr-cys equation.
Albuminuria
Chemistry
Kidney findings and red flags
Context
Transient albuminuria confounders
Creatinine may be unreliable
Complications (persistent)
Therapy
Documented history and special populations
More kidney cases
CKD-FX-001
Persistent moderately increased albuminuria with preserved GFR
Persistent moderately increased albuminuria with preserved GFR
CKD-FX-002
Persistent severely increased albuminuria with mildly decreased GFR
Persistent severely increased albuminuria with mildly decreased GFR
CKD-FX-003
Single reduced eGFR without chronicity
Single reduced eGFR without chronicity
CKD-FX-004
Acute creatinine rise before CKD staging
Acute creatinine rise before CKD staging
CKD-FX-005
Isolated suspected G3a requiring cystatin C confirmation support
Isolated suspected G3a requiring cystatin C confirmation support
CKD-FX-006
Combined eGFR reclassification support
Combined eGFR reclassification support
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