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Risk of Nephrolithiasis Associated With SGLT2 Inhibitors Versus DPP4 Inhibitors Among Patients With Type 2 Diabetes:
Anna Shin1, Ju-Young Shin2, Eun Ha Kang3
1Medical Research Collaboration Center, Seoul National University Bundang Hospital, Seongnam, Korea.
Diabetes Care
|December 12, 2024
Summary
Sodium-glucose cotransporter 2 inhibitors (SGLT2is) show a lower risk of kidney stones compared to dipeptidyl peptidase 4 inhibitors (DPP4is) in type 2 diabetes patients. This benefit was observed in both patients with no prior stone history and those with a history of kidney stones.
Area of Science:
- Nephrology
- Endocrinology
- Pharmacology
Background:
- Type 2 diabetes (T2D) management involves various drug classes.
- Nephrolithiasis is a potential complication in T2D patients.
- Sodium-glucose cotransporter 2 inhibitors (SGLT2is) and dipeptidyl peptidase 4 inhibitors (DPP4is) are common T2D medications with differing mechanisms.
Purpose of the Study:
- To compare the risk of incident nephrolithiasis between T2D patients initiating SGLT2is versus DPP4is.
- To analyze this risk stratified by prior history of kidney stones (never-formers vs. ever-formers).
Main Methods:
- Population-based cohort study using the Korea National Health Insurance Service database (2010-2021).
- 1:1 propensity score matching was employed for SGLT2i and DPP4i initiators.
- Incident nephrolithiasis was the primary outcome; osteoarthritis encounters served as a negative control.
Main Results:
- A total of 17,006 matched pairs were analyzed, including stone never-formers and ever-formers.
- SGLT2i initiators demonstrated a significantly lower risk of nephrolithiasis compared to DPP4i initiators (HR 0.54).
- Both stone never-formers (HR 0.43) and ever-formers (HR 0.64) showed reduced risk with SGLT2is, with greater absolute risk reduction in ever-formers.
Conclusions:
- SGLT2 inhibitors are associated with a reduced risk of kidney stones in T2D patients, irrespective of prior stone history.
- The relative risk reduction was higher in stone never-formers, while the absolute risk reduction was greater in stone ever-formers.
- Findings support SGLT2is as a potentially protective agent against nephrolithiasis in T2D.
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