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ACSL4 expression is increased in experimental kidney and intestinal IRI and this correlated with the severity of the injury.32,53 In addition, tubular ASCL4 expression was increased in human post-transplantation AKI.53 While ASCL4 activation contributes to ferroptosis, whether ACSL4 levels (not activity) provides information on ferroptosis occurrence is yet unclear

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The most serious but rare complication is metformin-associated lactic acidosis (MALA), typically occurring in the setting of renal impairment and mechanistically linked to mitochondrial complex I inhibition (Zhou et al., 2001)