Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark.
Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.
Diabetologia. 2021 Jul;64(7):1563-1571. doi: 10.1007/s00125-021-05424-4. Epub 2021 Mar 13.
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.
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.
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.
目的/假设：钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）通过增加尿量可能降低肾结石风险。我们旨在研究 SGLT2i 的起始治疗是否与降低肾结石风险相关。
我们使用丹麦健康登记系统进行了一项以活性对照药物为新使用者的队列研究，时间范围为 2012 年 11 月 11 日至 2018 年 12 月 31 日。年龄≥40 岁的患者，起始 SGLT2i 或胰高血糖素样肽-1 受体激动剂（GLP1 RAs）治疗后，直至肾结石住院或门诊诊断、死亡、移民或研究结束。新 SGLT2i 使用者按照倾向评分 1:1 匹配新 GLP1 RA 使用者。在补充分析中，在治疗开始前有肾结石病史的个体中评估了复发性肾结石的风险。
我们确定了 24290 名和 19576 名符合条件的 SGLT2i 和 GLP1 RA 新使用者，分别。匹配后，仍有 12325 对患者。中位年龄为 61 岁，中位随访时间为 2.0 年。SGLT2i 起始治疗者的肾结石发生率为每 1000 人年 2.0 例，GLP1 RA 起始治疗者为每 1000 人年 4.0 例，差异率为-1.9 例/1000 人年（95%CI-2.8，-1.0），HR 为 0.51（95%CI 0.37，0.71）。对于复发性肾结石（n=731 对患者），差异率为-17 例/1000 人年（95%CI-33，-1.5），HR 为 0.68（95%CI 0.48，0.97）。
结论/解释：SGLT2i 的起始治疗与肾结石的发病和复发风险显著降低相关。
