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Abstract: SA-PO259

Empagliflozin Use and the Risk of Nephrolithiasis in Patients With Type 2 Diabetes

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical


  • Paik, Julie M., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Tesfaye, Helen, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Zakoul, Heidi, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Schmedt, Niklas, Boehringer Ingelheim International GmbH, Ingelheim, Rheinland-Pfalz, Germany
  • Koeneman, Lisette, Lilly Deutschland GmbH, Bad Homburg, Hessen, Germany
  • Seman, Leo, Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, Connecticut, United States
  • Curhan, Gary C., Brigham and Women's Hospital, Boston, Massachusetts, United States
  • Wexler, Deborah J., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Patorno, Elisabetta, Brigham and Women's Hospital, Boston, Massachusetts, United States

Type 2 diabetes (T2D) is associated with an increased risk of kidney stones. Empagliflozin is a sodium-glucose cotransporter-2 inhibitor (SGLT2i) which might lower the risk of nephrolithiasis, potentially by increasing urinary flow. We investigated the association between empagliflozin use and the risk of nephrolithiasis in routine practice.


Using claims data from 2 private health plans and Medicare (2013-2019), we identified 102,275 pairs of 1:1 propensity score (PS)-matched adults with T2D initiating empagliflozin or a DPP4 inhibitor (DPP4i), and 115,489 pairs initiating empagliflozin or a GLP1 receptor agonist (GLP1RA). Our primary outcome was nephrolithiasis diagnosed by ICD codes in the inpatient or outpatient setting. We estimated hazard ratios (HRs), rate differences (RD) and 95% confidence intervals (CI), adjusting for 148 baseline covariates in the PS model.


Over a mean follow-up of ~8 months on treatment, the risk of nephrolithiasis was lower in the empagliflozin group compared with the DPP4i group (HR 0.72 [95%CI 0.67-0.78]; RD/1,000 person-years -6.2 [95%CI -7.6, -4.8]) and the GLP1RA group (HR 0.73 [95%CI 0.68-0.79]; RD/1,000 person-years -6.0 [95%CI -7.4, -4.6]) (see Table). Secondary definitions of the outcome based on a hospital discharge diagnosis produced consistent results.


In routine care, empagliflozin use was associated with a reduced risk of nephrolithiasis, compared to DPP4i and GLP1RA use in patients with T2D.


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