Dipeptidyl peptidase 4 inhibitor linagliptin can decrease the dosage of erythropoiesis-stimulating agents in patients on hemodialysis

Background Dipeptidyl peptidase 4 (DPP4) inhibitors are very useful for the treatment of type 2 diabetes, especially to patients undergoing hemodialysis (HD). The main action of DPP4 inhibitors is to increase the concentration of incretin which stimulate the insulin secretion from pancreatic beta cells. Recently, the extra-pancreatic actions of DPP4 inhibitors were suggested by many reports; a study has shown that hematopoiesis in mice after radiation or chemotherapy was enhanced receiving an oral DPP4 inhibitor sitagliptin. It suggests the possibility that DPP4 inhibitors can reduce the dosage of erythropoiesis-stimulating agents (ESAs) in HD patients. But there is no clinical report about the effect of DPP4 inhibitors on renal anemia in HD patients. This study was designed to confirm the clinical effect of DPP4 inhibitors on the reduction of dosage of ESA or improvement of renal anemia.