Abstract: FR-PO0274
GLP-1 Receptor Agonist Semaglutide and Risk of Incident Urinary Stone Disease
Session Information
- Bone and Mineral Metabolism: Clinical Epidemiology and Outcomes
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Ganesan, Calyani, Stanford University School of Medicine, Stanford, California, United States
- Kim, Sun H., Stanford University School of Medicine, Stanford, California, United States
- Chang, Timothy Chan, Stanford University School of Medicine, Stanford, California, United States
- Conti, Simon, Stanford University School of Medicine, Stanford, California, United States
- Leppert, John, Stanford University School of Medicine, Stanford, California, United States
- Pao, Alan C., Stanford University School of Medicine, Stanford, California, United States
Background
Obesity is associated with an increased risk of urinary stones. Glucagon-like peptide-1 receptor agonists (GLP1-RAs) might lower risk of urinary stone disease by reducing urinary excretion of lithogenic minerals or by reducing body weight, which could improve insulin sensitivity and urinary parameters associated with insulin resistance. A recent study in the Veterans Health Administration demonstrated that treatment of patients with GLP1-RAs was associated with a suprisingly higher risk of urinary stone disease. However, more data is needed to determine the effect of GLP1-RAs on incident urinary stone disease in a broader population.
Methods
To investigate the association between use of GLP1-RAs and stone risk in clinical practice, we conducted a retrospective cohort study with electronic health records collected from approximately 66 million patients who were newly prescribed semaglutide (intervention) or metformin (active comparator) for at least three months between January 2016 and December 2023 using the Apollo dataset. Cohorts were matched by high-dimensionality propensity scoring. The primary outcome was a diagnosis of urinary stone disease consisting of either an ICD-10 code for diagnosis of urinary stone disease or a ICD-10/CPT code for urinary stone procedure.
Results
After propensity score matching, a total of 30,954 adults (15,477 pairs) initiating semaglutide or metformin were included in the study cohort (mean [SD] age, 51.8 [13.3] vs 51.4 [15.9]; 70.2% vs 71.1% female; baseline BMI [SD], 36.9 [7] vs 35.8 [8.1]; diabetes 32% vs 31%). Over a mean [SD] follow-up of 780 [321] days for the semaglutide group and 1041 [451] days for the metformin group, the risk for a urinary stone event was similar for both groups (hazard ratio 0.94, 95% CI (0.83, 1.06), p = 0.3). For the subgroup of patients with available information about BMI (N=5,953 for semaglutide or metformin), mean difference for BMI was lower after intervention in the semaglutide group compared with the metformin group (-1.7, 95% CI (-1.9, -1.6, p <0.001).
Conclusion
These findings do not demonstrate a statistically significant association between semaglutide use and incident urinary stone disease. Future studies are needed to determine whether the effect of GLP-1RAs on stone disease differs among individuals at higher risk for stone formation.
Funding
- NIDDK Support