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 ?
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