Chung Mu-Chi, Lin Chia-Yen, Chang Chao-Hsiang, Chang Yi-Huei, Hsiao Po-Jen, Lien Chi-Shun, Wu Laing-You, Wu Ming-Ju, Shieh Jeng-Jer, Hung Peir-Haur, Chen Hsin-Hua, Chung Chi-Jung
Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Clin Pharmacol Ther. 2025 Jun;117(6):1775-1783. doi: 10.1002/cpt.3626. Epub 2025 Mar 10.
The benefits of sodium-glucose transport protein 2 inhibitor (SGLT2i) use on severe urolithiasis requiring surgery remains unclear. All patients with incident T2D in Taiwan National Health Institution databases (2016-2021) and TriNetX datasets (2014-2023) were retrospectively analyzed. The study analyzed a propensity score-matched pairs with T2D treated with SGLT2i or dipeptidyl peptidase 4 inhibitors (DPP4i). The primary outcome was the incidence of urolithiasis and urolithiasis requiring surgery during the study period. Urolithiasis diagnoses were identified using International Classification of Diseases diagnostic codes and categorized into upper and lower urinary tract stones. Cases of urolithiasis requiring surgery were determined by the presence of both diagnostic codes and surgical procedure codes within the same outpatient visit or hospitalization. Conditional and time-dependent Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During the study period, 5700 participants were diagnosed with urolithiasis, 1297 participants were urolithiasis requiring surgery in Taiwan NHIRD cohort 8438 participants with urolithiasis as well as 289 participants with urolithiasis requiring surgery were in the TriNetX cohort. Adjusted HRs of urolithiasis and urolithiasis requiring surgery were 0.82-fold (95% CI, 0.77-0.87), 0.72-fold (95% CI, 0.63-0.82) in Taiwan NHIRD, 0.84 (95% CI, 0.78-0.90), and 0.62 (95% CI, 0.44-0.88) in TriNetX cohort respectively. Similar protective associations with SGLT2i use against urolithiasis were observed across subgroups in both datasets from Taiwan NHIRD and TriNetX. In conclusion, SGLT2i might protect against kidney stones and severe cases requiring surgery in T2D patients.
钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）用于治疗需要手术的严重尿路结石的益处仍不明确。对台湾国民健康保险机构数据库（2016 - 2021年）和TriNetX数据集（2014 - 2023年）中所有新发2型糖尿病患者进行了回顾性分析。该研究分析了倾向评分匹配的接受SGLT2i或二肽基肽酶4抑制剂（DPP4i）治疗的2型糖尿病患者对。主要结局是研究期间尿路结石和需要手术的尿路结石的发生率。使用国际疾病分类诊断代码确定尿路结石诊断，并分为上尿路结石和下尿路结石。需要手术的尿路结石病例通过在同一门诊就诊或住院期间同时存在诊断代码和手术程序代码来确定。使用条件和时间依赖性Cox比例风险回归模型来估计风险比（HRs）和95%置信区间（CIs）。在研究期间，台湾国民健康保险研究数据库队列中有5700名参与者被诊断为尿路结石，1297名参与者患有需要手术的尿路结石；TriNetX队列中有8438名尿路结石参与者以及289名需要手术的尿路结石参与者。台湾国民健康保险研究数据库中，尿路结石和需要手术的尿路结石的调整后HR分别为0.82倍（95%CI，0.77 - 0.87）、0.72倍（95%CI，0.63 - 0.82）；TriNetX队列中分别为0.84（95%CI，0.78 - 0.90）和0.62（95%CI，0.44 - 0.88）。在台湾国民健康保险研究数据库和TriNetX的两个数据集中，各亚组中均观察到SGLT2i使用与预防尿路结石的类似保护关联。总之，SGLT2i可能对2型糖尿病患者预防肾结石及需要手术的严重病例具有保护作用。
