Sodium-Glucose Cotransporter 2 Inhibitors and Nephrolithiasis Risk in Patients With Type 2 Diabetes
Authors' conclusion
These findings suggest that in adults with T2D, SGLT2i use may lower the risk of nephrolithiasis compared with GLP-1RAs or DPP4is and could help to inform decision-making when prescribing glucose-lowering agents for patients who may be at risk for developing nephrolithiasis.
Study context
- Population
- Commercially insured adults (≥18 years) with T2D initiating SGLT2i, GLP-1 RA or DPP-4i, April 2013–December 2020, USmatched pairs
- Exposure
- SGLT2i vs GLP-1 RA or DPP-4i
- Outcome
- Nephrolithiasis diagnosed by ICD codes in the inpatient or outpatient setting
- Follow-up
- Median 192 (IQR, 88-409) days
Methodological detailsnew-user, active comparator, 1:1 propensity score matched, pairwise comparisons
- New-user
- Active comparator
- 1:1 propensity score matched
- Pairwise comparisons
Main finding
As reported in the abstract
Nephrolithiasis · median follow-up 192 days
Hazard ratio (95% CI)
SGLT2ivs GLP-1RA14.9 vs 21.3 events per 1000 person-years; 358 203 matched pairs (716 406 adults)
0.69(0.67–0.72)
SGLT2ivs DPP4i14.6 vs 19.9 events per 1000 person-years; 331 028 matched pairs (662 056 adults)
0.74(0.71–0.77)
RD (95% CI)
SGLT2ivs GLP-1RA
−6.4(−7.1 to −5.7)
SGLT2ivs DPP4i
−5.3(−6.0 to −4.6)
Observational data: associations, not effects.
Further findings
Nephrolithiasis, SGLT2i association by subgroup (sex, race and ethnicity, history of CKD, obesity)
- Association between SGLT2i use and nephrolithiasis risk was similar by sex, race and ethnicity, history of CKD and obesity
Nephrolithiasis, SGLT2i risk reduction by age (aged younger than 70 years vs aged 70 years or older)
- Magnitude of risk reduction with SGLT2i larger among adults aged younger than 70 years vs aged 70 years or older: HR
- 0.85 (95% CI, 0.79-0.91)
- RD per 1000 person-years
- −3.46 (95% CI, −4.87 to −2.05)
- P for interaction
- <.001
Original publication
Sodium-Glucose Cotransporter 2 Inhibitors and Nephrolithiasis Risk in Patients With Type 2 Diabetes. JAMA Intern Med. Published 1 March 2024. doi:10.
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