This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: All India exam, Subject name: Pharmacology
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 ? 
Select and explain. 
A. Stop sitagliptin and sta linagliptin, B. stop metaformin and change her to subcutaneous insulin, C. nsaids are stoped and opiods are used for ahritis pain, D. all of the above
D: all of the above
Answer: D: all of the above 
Explanation: 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