PKD1 and autosomal dominant polycystic kidney disease: However, mixed results in animal models of PKD (Takiar et al., 2011; Leonhard et al., 2019; Lian et al., 2019; Chang et al., 2022; Pastor-Soler et al., 2022) and increased plasma lactate levels observed in Pkd1 miRNA transgenic mice, call for a careful examination of the risk benefit of metformin especially in patients with later stage of ADPKD (Chang et al., 2022).