May 2024
SGLT-2 inhibitors lower risk for kidney stones in patients with type 2 diabetes

This drug class, compared with other diabetes drugs, was associated with lower risk.

Type 2 diabetes is associated with excess risk for kidney stones. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors increase urine output and alter urine composition in ways that might lower risk for kidney stones. In this US. study, researchers compared risks for kidney stones among 600,000 adults with type 2 diabetes who were new users of SGLT-2 inhibitors versus 600,000 propensity score-matched patients who initiated glucagon-like peptide-1 (GLP-1) receptor agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors, which do not have the same renal effects.

During median follow up of six months, risk for kidney stones was significantly lower in patients who began using SGLT-2 inhibitors than in patients who began using GLP-1 receptor agonists (15 vs 22 events/1000 person-years) or DPP-4 inhibitors (15 vs 20 events/1000 person-years). The effect was larger for younger patients (age, below 70 years).

Comment: This study suggests that initiating SGLT-2 inhibitors, compared with GLP-1 receptor agonists or DPP-4 inhibitors, is associated with lower risk for kidney stones in the short term; whether this effect will persist long term is unknown. For a patient in whom the decision to start an SGLT-2 inhibitor (versus another diabetes drug) is otherwise a toss-up, a history of recurrent kidney stones might tip the balance toward the
SGLT-2 inhibitor.

Paul S. Mueller, MD, MPH, FACP, Regional Vice President – Southwest Wisconsin, Mayo Clinic Health System, La Crosse; Professor of Medicine and Biomedical Ethics, Mayo Clinic College of Medicine and Science, Rochester, USA.

Paik JM, et al. Sodium-glucose cotransporter 2 inhibitors and nephrolithiasis risk in patients with type 2 diabetes. JAMA Intern Med 2024; 184: 265-274.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine.

JAMA Intern Med