What are the considerations for using Glipizide (Glipizide) in a patient with Chronic Kidney Disease (CKD) and impaired renal function, specifically a glomerular filtration rate (GFR) of 29?

From the Guidelines

Glipizide can be used with caution in patients with a GFR of 29 ml/min (severe CKD stage 4), but dose adjustment is recommended, starting with a low dose of 2.5 mg daily and titrating slowly based on blood glucose response and monitoring for hypoglycemia, as suggested by the most recent guidelines 1.

Key Considerations

• Glipizide is primarily metabolized by the liver with inactive metabolites excreted by the kidneys, making it generally safer than some other sulfonylureas in kidney disease 1.
• Patients with this level of kidney dysfunction have increased risk of hypoglycemia due to decreased renal clearance of insulin and prolonged drug half-life 1.
• Close monitoring of blood glucose levels is essential, especially during initiation and dose adjustments 1.
• Consider alternative agents like linagliptin or repaglinide if hypoglycemic episodes occur, as they have a more favorable profile in patients with CKD 1.

Dosing and Monitoring

• Start with a low dose of 2.5 mg daily and titrate slowly based on blood glucose response and monitoring for hypoglycemia 1.
• The maximum dose should be reduced to about 10 mg daily in this setting, to minimize the risk of hypoglycemia 1.
• Regularly assess kidney function, as further deterioration may necessitate medication changes 1.

Alternative Agents

• Linagliptin and repaglinide are alternative agents that can be considered in patients with CKD, as they have a lower risk of hypoglycemia and do not require dose adjustment in patients with a GFR of 29 ml/min 1.
• Other agents, such as SGLT2 inhibitors and GLP-1 receptor agonists, may also be considered, but their use should be individualized based on the patient's specific needs and kidney function 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. In elderly patients, debilitated or malnourished patients, and patients with impaired renal or hepatic function, the initial and maintenance dosing should be conservative to avoid hypoglycemic reactions

The patient with a GFR of 29 has impaired renal function.

• The metabolism and excretion of glipizide may be slowed in this patient.
• Hypoglycemia may be prolonged if it occurs.
• Initial and maintenance dosing should be conservative to avoid hypoglycemic reactions 2.
• The patient should be closely monitored for hypoglycemia and other adverse effects.
• Dose adjustments may be necessary to minimize the risk of hypoglycemia.

From the Research

Glipizide in CKD with GFR of 29

• The use of glipizide in patients with chronic kidney disease (CKD) and a glomerular filtration rate (GFR) of 29 has been studied in various research papers 3, 4, 5, 6, 7.
• According to a study published in 2018, sitagliptin probably reduces hypoglycaemia compared to glipizide in patients with diabetes and CKD 3.
• The same study found that compared to glipizide, sitagliptin may have little or no effect on HbA1c, FBG, weight, and eGFR in patients with diabetes and CKD 3.
• Another study published in 2022 found that the use of SGLT2 inhibitors or GLP-1RAs was associated with a lower risk of hypoglycemia compared to sulfonylureas in patients with CKD and type 2 diabetes 6.
• However, there is limited evidence on the use of glipizide specifically in patients with CKD and a GFR of 29, and more research is needed to guide therapeutic choices in this population 3, 4, 5, 6, 7.
• A study published in 2025 discussed the use of combination therapy in CKD, including the use of SGLT2 inhibitors, GLP-1RAs, and other medications, but did not specifically address the use of glipizide in patients with CKD and a GFR of 29 7.
• The management of diabetes in patients with CKD requires special consideration due to changes in glucose and insulin homeostasis, and altered metabolism of glucose-lowering therapies 4.
• Glycemic goals should be individualized, considering CKD severity, presence of macrovascular and microvascular complications, and life expectancy 4.
• The use of glucose-lowering agents in patients with CKD should be guided by the individual patient's needs and medical history, and should be monitored closely for potential side effects and interactions 3, 4, 5, 6, 7.