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 The FDA drug label does not answer the question.
From the Research
Glipizide can potentially worsen kidney function in certain patients, particularly those with pre-existing kidney disease, due to its indirect effects on kidney function through hypoglycemia and prolonged effects in patients with kidney impairment. Glipizide is a sulfonylurea medication used to treat type 2 diabetes by stimulating insulin release from the pancreas. While glipizide itself is not directly nephrotoxic, it can indirectly affect kidney function through several mechanisms. The medication can cause hypoglycemia (low blood sugar), which may lead to acute kidney injury in vulnerable patients. Additionally, glipizide is primarily metabolized by the liver but excreted by the kidneys, so its effects can be prolonged in patients with kidney impairment, potentially leading to more hypoglycemic episodes.
For patients with moderate to severe kidney disease (eGFR less than 60 mL/min), dose adjustments may be necessary, and in very advanced kidney disease, alternative diabetes medications might be preferred 1. Regular monitoring of kidney function is important for patients taking glipizide, especially those with existing kidney problems, diabetes-related kidney disease, or the elderly who are more susceptible to adverse effects. The use of race-free estimated glomerular filtration rate (eGFR) equations, as recommended by the National Kidney Foundation, can help improve medication-related decision-making in adults with stable kidney function 2.
Some studies have compared the efficacy and safety of glipizide with other diabetes medications, such as sitagliptin, in patients with type 2 diabetes and moderate-to-severe chronic renal insufficiency 1. These studies have shown that sitagliptin may have a lower risk of hypoglycemia and weight gain compared to glipizide. However, the most recent and highest quality study on this topic is from 2013, and more recent studies are needed to confirm these findings.
In terms of predicting cardio-renal outcomes in patients with type 2 diabetes mellitus and kidney disease, albuminuria, serum creatinine, and estimated glomerular filtration rate (eGFR) are pivotal indicators of kidney decline 3. However, the use of these biomarkers to predict kidney disease progression and cardio-renal outcomes is still an area of ongoing research, and more studies are needed to fully understand their clinical significance.
Overall, while glipizide can be an effective medication for managing type 2 diabetes, its potential effects on kidney function must be carefully considered, particularly in patients with pre-existing kidney disease. Regular monitoring of kidney function and dose adjustments as needed can help minimize the risk of adverse effects.