<prompt> a female patient of age 53yrs is known case of osteoahritis diabetic using METFORMIN 500mg , sitagliptin , glimipride 1mg since 10years. patient was recently diagnosed with CKD due to vigrous nsaid usage , now regarding her management what is the next step ?Stop sitagliptin and sta linagliptinstop metaformin and change her to subcutaneous insulinnsaids are stoped and opiods are used for ahritis painall of the above  <response>: sitagliptin and metaformin are excreated by kidneys and so they are stopped and linagliptin and humaninsulin is staed. opiods like tramadol have least renal toxicity . ref : kd tripathi 8th ed 