SGLT2 Inhibitors Linked to Lower Risk of Kidney Stones in Patients With Type 2 Diabetes: Study Shows
Thailand: Use of sodium-glucose co-transporter-2 inhibitors (SGLT2is) may help reduce the risk of kidney stone formation in individuals with type 2 diabetes (T2D) without increasing the likelihood of urinary tract infections (UTIs), according to new research published in Diabetology & Metabolic Syndrome. The retrospective cohort study highlights potential renal benefits of SGLT2i beyond glucose control.
Dr. Thitiya Lukkunaprasit, Department of Social and Administrative Pharmacy, College of Pharmacy, Rangsit University, Pathum Thani, Thailand, and colleagues utilized real-world data from Ramathibodi Hospital, Bangkok, and included 17,821 adult T2D patients treated between 2015 and 2023. Of these, 5,626 patients received SGLT2 inhibitors, while others were prescribed dipeptidyl peptidase-4 inhibitors (DPP4is), sulfonylureas (SUs), or thiazolidinediones (TZDs). The median follow-up duration was 1.8 years.
The following were the key findings of the study:
- The incidence of nephrolithiasis was markedly lower in patients treated with SGLT2 inhibitors than in those using other antidiabetic drugs.
- Incidence rates per 1,000 person-years were 7.7 for SGLT2is, 18.5 for DPP4is, 20.5 for SUs, and 12.1 for TZDs.
- After adjustment, SGLT2 inhibitor use was linked to a significantly reduced risk of nephrolithiasis compared with DPP4is (HR 0.45), SUs (HR 0.37), and TZDs (HR 0.60).
- Regarding urinary tract infections, SGLT2 inhibitor users had a slightly lower incidence compared to DPP4is (HR 0.85) and TZDs (HR 0.78).
- A statistically significant reduction in UTI risk was noted only when compared with SUs (HR 0.74).
- Overall, SGLT2 inhibitors were associated with a lower likelihood of kidney stone formation without increasing the risk of urinary tract infections.
The authors pointed out that diabetes itself is an established risk factor for nephrolithiasis, and racial, dietary, and environmental factors can influence this risk. Their findings provide real-world evidence supporting the use of SGLT2 inhibitors for renal protection among Thai T2D patients.
However, the researchers also acknowledged several limitations. Data on dietary habits and fluid intake—key contributors to kidney stone formation—were unavailable, which could have influenced the analysis. Moreover, information regarding the severity or recurrence of nephrolithiasis and UTIs was limited. Since SGLT2 inhibitors were introduced in Thailand only after 2015, the relatively short median follow-up period may also restrict the long-term generalizability of the results.
Despite these constraints, the study provides valuable insights into the broader clinical benefits of SGLT2 inhibitors. Dr. Lukkunaprasit and colleagues concluded that SGLT2i therapy may serve as a promising option for reducing kidney stone risk in type 2 diabetes patients without adding to UTI burden. They emphasized the need for future large-scale studies with extended follow-up and more detailed clinical data to confirm these findings and identify patient subgroups most likely to benefit.
"Overall, the study supports expanding the role of SGLT2 inhibitors in diabetes management — offering both metabolic and renal protection in real-world settings," the authors concluded.
Reference:
Lukkunaprasit, T., Tansawet, A., Siriyotha, S. et al. Effects of sodium-glucose co-transporter-2 inhibitors on the risk of nephrolithiasis and urinary tract infections in Thai patients with type 2 diabetes: a hospital-based cohort study. Diabetol Metab Syndr 17, 400 (2025). https://doi.org/10.1186/s13098-025-01979-z
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