DPP4 and Renal insufficiency: The features of linagliptin are xanthine-based compounds which differ from the other DPP-4 inhibitors with higher selectivity for DPP-4 versus DPP-8 (40,000-fold) and DPP-9 (> 10,000-fold) [18, 19] and no dosage adjustment in renal insufficiency including end-stage renal disease because of primarily eliminated via the enterohepatic system [20].