Patients with type 2 diabetes using SGLT-2 inhibitors experienced a 33% lower rate of kidney stone recurrence compared to those on other diabetes medications, according to a recent study.

The study evaluated the effectiveness of sodium-glucose cotransporter-2 (SGLT-2) inhibitors in reducing nephrolithiasis recurrence among patients with type 2 diabetes and a history of nephrolithiasis, including those with concurrent gout. Using a target trial emulation approach, researchers compared SGLT-2 inhibitors with glucagon-like peptide-1 (GLP-1) receptor agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors, analyzing data from the Canadian population database from 2014 to 2022.

Results published in The BMJ indicated that patients initiating SGLT-2 inhibitors had a lower rate of recurrent nephrolithiasis than those starting GLP-1 receptor agonists. After inverse probability weighting, SGLT-2 inhibitor users experienced 105.3 nephrolithiasis events per 1,000 person-years, compared with 156.4 per 1,000 person-years for GLP-1 receptor agonist users, yielding an adjusted rate ratio of 0.67 (95% confidence interval [CI], 0.57-0.79) and a rate difference of -51 per 1,000 person-years. The corresponding number needed to treat (NNT) was 20. Among patients with recent active nephrolithiasis, the rate difference was more pronounced at -219 per 1,000 person-years (NNT, 5).

In patients with both nephrolithiasis and gout, SGLT-2 inhibitors were associated with a reduced recurrence risk for both conditions. Compared with GLP-1 receptor agonists, the rate ratio for recurrent gout flare-ups was 0.72 (95% CI, 0.54-0.95), with a rate difference of -16 per 1,000 person-years. The reduction was more evident when compared with DPP-4 inhibitors (rate ratio, 0.65; 95% CI, 0.52-0.82). SGLT-2 inhibitor use was also linked to a higher incidence of genital infections (hazard ratio, 2.21; 95% CI, 1.68-2.90).

These findings suggest that SGLT-2 inhibitors may play a role in managing nephrolithiasis and gout recurrence among patients with type 2 diabetes, based on their association with reduced recurrence rates.

Full disclosures can be found in the published study.