A 75 year old male with Type 2 Diabetes and Ischaemic Heart Disease attends for his annual medication review. His blood pressure is 122/69 mmHg and pulse 72bpm. He is compliant with all his medications which include Metformin 500mg tds, Ramipril 5mg od, Amlodipine 10mg od, Linagliptin 5mg od, Aspirin 75mg od, Bisoprolol 2.5mg od and Atorvastatin 40mg od.
His latest bloods show the following
Hb – 122 g/L
Urea – 9.2 mmol/L
Creatinine – 112 µmol/L
GFR – 39 mL/min
Liver function tests – Unremarkable
HbA1c – 72 mmol/mol
Which one of his medications requires the dose to be modified?