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A 50-year-old patient with a history of Type 2 diabetes and chronic kidney disease presents to the clinic for a medication review. The patient's current medication regimen includes metformin for glycemic control. The healthcare provider is concerned about the use of metformin in patients with renal impairment and wants to assess the potential risks. Which of the following complications is most likely to occur if metformin is utilized in renal impairment?
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E