DPP4 and chronic kidney disease: A similar caution is advised with the use of insulin secretagogues in CKD patients because the dipeptidyl peptidase-4 (DPP-4) inhibitors saxagliptin, sitagliptin, and vildagliptin (but not linagliptin) are predominantly excreted by kidneys; therefore, dose reduction is necessary in patients with CKD.