Objective Linagliptin is supposed to be safer than other dipeptidyl peptidase-4 (DPP4) inhibitors to the patients with renal failure, because linaglitptin is primary excreted into stool and renal excretion is minor. Therefore, I n this study we investigated the efficacy and safety of linagliptin compared to α-glucosidase inhibitor as an add-on therapy in Japanese patients with type 2 diabetes and chronic renal failure. Methods We retrospectively investigated the patients with type 2 diabetes with chronic renal failure (serum creatinine > 2.0 mg/dL) who were added linagliptin (Group L) or α-glucosidase inhibitor (Group A) from January 2007 to May 2013 in our database. HbA1c before and 3 months after and occurrence of adverse events such as hypoglycemia were studied. Results In Group L, 8 cases (5 males) were included, and 7 cases (7 males) were included in Group A. There were no significant differences between two groups in baseline age (68 ± 9, 68 ± 11), sex, weight (63.6 ± 19.7 kg, 72.5 ± 12.3 kg), hemoglobin (11.4 ± 1.6 g/dL, 11.1 ± 0.6 g/dL), serum creatinine (5.9 ± 4.1 mg/dL, 4.4 ± 4.2 mg/dL), and HbA1c. After 3 months, HbA1c was decreased significantly in Group L (from 7.4 ± 0.4% to 6.7 ± 0.3%; P < 0.05), whereas there was no significant change in Group A (from 7.7 ± 0.3% to 7.5 ± 0.3%; P = 0.32). In both groups, no adverse event (e.g. hypoglycemia) was observed. Conclusion In patients with type 2 diabetes and chronic renal failure, linagliptin was suggested to be more effective than α-glucosidase inhibitor as an add-on therapy.