Abstract: SA-PO0577
Association of SGLT2 Inhibitor Use with Urinary Supersaturation and Kidney Stone Recurrence in a Large Stone Clinic Population
Session Information
- Top Trainee Posters - 3
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 01:18 PM - 01:24 PM
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Zaher, Ahmed Abdelnaby Aly Mahmoud, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Alshareef, Abdulmueti, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Jayachandran, Muthuvel, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Titan, Silvia, Mayo Clinic Minnesota, Rochester, Minnesota, United States
- Lieske, John C., Mayo Clinic Minnesota, Rochester, Minnesota, United States
Background
SGLT2 inhibitor (SGLT2i) use is associated with lower urinary stone disease (USD) prevalence in large surveys, but the effects on 24-hr urinary supersaturation (SS), chemistries, and USD recurrence in stone formers are unclear.
Methods
A retrospective propensity score (PS) matched cohort study of adults followed in the Mayo Stone Clinic and ≥2 available 24-hr urinary SS studies. Eligible SGLT2i users had pre/post SS studies around their index SGLT2i prescription. Non-users were matched for time from USD diagnosis to the time of the SGLT2i prescription and having available pre/post SS studies for that date. Mixed effects difference in differences (DiD) models evaluated closest-pair and repeated urine values within ±1yr. Cox models assessed CPT stone procedure codes or emergency department (ED) visits for stone events over 2-3 yrs; events within 90 days were counted as 1.
Results
144 SGLT2i users and 414 matched non-users were studied. In closest pair analysis, SGLT2i use was associated with significant reductions in calculated brushite (BR) and calcium oxalate (CaOx) SS (Table 1). In repeated measures analysis, BR, CaOx, and hydroxyapatite (HA) SS were all significantly reduced, while uric acid (UA) SS did not change. In the exposed group, 24-hr volume and citrate trended higher while calcium and sodium trended lower. Stone events by CPT-code (HR 0.98, 95% CI (0.53-1.80); p=0.94) or CPT/ED (HR 0.75, 95% CI (0.41-1.35); p=0.33) did not differ.
Conclusion
SGLT2i use was associated with lower BR, HA and CaOx SS, likely due to combined changes in urinary volume, calcium, pH and citrate. Recurrence rates requiring surgery and/or ED visits over 2-3 yrs showed no difference. The findings suggest SGLT2i use favorably shifts urinary lithogenic risk, but larger studies are needed to evaluate potential effects on clinical outcomes.