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A 75 year old male with Type 2 Diabetes and Ischaemic Heart Disease attends Diabetic clinic. His blood pressure is 122/69 mmHg and pulse 72bpm. He is compliant with all his medications which include Metformin 500mg three times a day, Ramipril 5mg, Amlodipine 10mg OD, Linagliptin 5mg OD, Aspirin 75mg OD, Bisoprolol 2.5mg OD and Atorvastatin 40mg.

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?

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