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Comment & Response
October 2018

Lactic Acidosis, Metformin Use, and Dose-Response Association—Reply

Author Affiliations
  • 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 2Division of Nephrology, Monash Medical Centre, Clayton, Australia
  • 3Department of Medicine, Johns Hopkins University, Baltimore, Maryland
JAMA Intern Med. 2018;178(10):1427-1428. doi:10.1001/jamainternmed.2018.4430

In Reply We used the term lactic acidosis in the title of our study1 to be consistent with previous literature and to facilitate study identification.2 However, our study1 does not use lactate concentration to define acidosis events. In addition, our study is observational, and the ability to infer causality—even with techniques such as propensity score matching and active comparator analyses—is limited.

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