From the Guidelines
Glipizide can be used in patients with Chronic Kidney Disease (CKD), but it requires careful dose adjustment and monitoring to minimize the risk of hypoglycemia, particularly in those with severe CKD (eGFR <30 mL/min) 1.
Key Considerations
- Glipizide is preferred over other sulfonylureas in CKD because it does not have active metabolites and does not increase the risk of hypoglycemia in patients with CKD 1.
- For patients with mild to moderate CKD (eGFR >30 mL/min), glipizide can typically be used at standard doses starting at 2.5-5 mg daily.
- However, for patients with severe CKD (eGFR <30 mL/min), the risk of hypoglycemia increases significantly, and alternative agents like insulin or certain DPP-4 inhibitors may be safer options 1.
Dosing and Monitoring
- If glipizide must be used in patients with advanced CKD, start with the lowest possible dose (2.5 mg daily) and monitor blood glucose levels closely 1.
- Educate patients about recognizing and managing hypoglycemia symptoms, as the risk of prolonged hypoglycemia is particularly dangerous in this vulnerable population.
Alternative Options
- Insulin and certain DPP-4 inhibitors may be safer options for patients with severe CKD (eGFR <30 mL/min) due to the increased risk of hypoglycemia associated with glipizide in this population 1.
- Metformin should not be given to patients with serum creatinine concentrations of 1.5 mg/dL or greater in men and 1.4 mg/dL or greater in women due to the risk of lactic acidosis 1.
From the FDA Drug Label
Renal and Hepatic Disease:The metabolism and excretion of glipizide may be slowed in patients with impaired renal and/or hepatic function If hypoglycemia should occur in such patients, it may be prolonged and appropriate management should be instituted. Renal or hepatic insufficiency may cause elevated blood levels of glipizide and the latter may also diminish gluconeogenic capacity, both of which increase the risk of serious hypoglycemic reactions.
Key Considerations:
- Glipizide metabolism and excretion may be slowed in patients with impaired renal function.
- Renal insufficiency may cause elevated blood levels of glipizide, increasing the risk of serious hypoglycemic reactions.
- Caution is advised when using glipizide in patients with Chronic Kidney Disease (CKD).
- Initial and maintenance dosing should be conservative to avoid hypoglycemic reactions in patients with impaired renal function 2.
From the Research
Safety of Glipizide in Patients with Chronic Kidney Disease (CKD)
- Glipizide is a sulfonylurea that can be used in patients with CKD, but its use requires careful consideration of the patient's renal function and the risk of hypoglycemia 3, 4.
- According to some studies, glipizide does not require dose adjustment in patients with CKD, but it should be avoided in cases of advanced kidney disease due to the risk of hypoglycemia 3.
- Other studies suggest that sulfonylureas with limited renal clearance, such as glipizide, are an alternative to metformin and may be more effective than repaglinide on glycemic control 4.
- However, the use of glipizide in patients with CKD should be evaluated carefully, and dosing adjustments may be necessary to minimize the risk of hypoglycemia 4.
Key Considerations
- Patients with CKD are at high risk of hypoglycemia, and close monitoring of glucose levels is necessary to minimize this risk 5.
- The management of diabetes in patients with CKD requires individualized care, taking into account the patient's renal function, life expectancy, and comorbidities 3, 6.
- Other antidiabetic agents, such as DPP-4 inhibitors, incretin analogues, and SGLT-2 inhibitors, may have potential nephroprotective effects, but their use in patients with CKD should be carefully evaluated 4.