Overall, it appears that the impact of DPP-4 inhibitors on renal outcomes is modest at best, a finding supported by a meta-analysis of 36 DPP-4 inhibitor RCTs (excluding CARMELINA) which concluded that there was no impact on the risk of renal failure (RR 1.06 [95% CI 0.88, 1.27])29. This evidence concerns the gene DPP4 and acute kidney injury.