Sodium–glucose cotransporter 2 inhibitors and risk of nephrolithiasis

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Abstract

Aims/hypothesis: Sodium–glucose cotransporter 2 inhibitors (SGLT2Is) may reduce nephrolithiasis risk by increasing urine flow. We aimed to investigate whether initiation of SGLT2I was associated with reduced nephrolithiasis risk. Methods: We conducted an active-comparator new-user cohort study using the Danish health registries in the period 11 November 2012 to 31 December 2018. Individuals aged ≥40 years initiating SGLT2Is or glucagon-like peptide-1 receptor agonists (GLP1 RAs) were followed from treatment initiation until an inpatient or outpatient diagnosis of nephrolithiasis, death, emigration or end of study. New users of SGLT2Is were matched 1:1 on propensity scores to new users of GLP1 RAs. In supplementary analyses, risk of recurrent nephrolithiasis was assessed in individuals with a history of nephrolithiasis before treatment initiation. Results: We identified 24,290 and 19,576 eligible users of SGLT2Is and GLP1 RAs, respectively. After matching, 12,325 patient pairs remained. The median age was 61 years and median follow-up was 2.0 years. The nephrolithiasis rate was 2.0 per 1000 person-years in SGLT2I initiators compared with 4.0 per 1000 person-years in GLP1 RA initiators, with a rate difference of −1.9 per 1000 person-years (95% CI −2.8, −1.0) and an HR of 0.51 (95% CI 0.37, 0.71). For recurrent nephrolithiasis (n = 731 patient pairs), the rate difference was −17 per 1000 person-years (95% CI −33, −1.5) and the HR was 0.68 (95% CI 0.48, 0.97). Conclusions/interpretation: Initiation of treatment with SGLT2Is was associated with a clinically significant reduced risk of incident and recurrent nephrolithiasis. Graphical abstract: [Figure not available: see fulltext.].

Original languageEnglish
JournalDiabetologia
Volume64
Issue number7
Pages (from-to)1563-1571
ISSN0012-186X
DOIs
Publication statusPublished - Jul 2021

Keywords

  • Cohort studies
  • Databases
  • Dipeptidyl peptidase 4 inhibitors
  • Glucagon–like peptide 1 receptor agonists
  • Nephrolithiasis
  • Observational studies
  • Sodium–glucose cotransporter 2 inhibitors
  • Type 2 diabetes

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