EMPAGLIFLOZIN USE AND THE RISK OF NEPHROLITHIASIS IN PATIENTS WITH TYPE 2 DIABETES
Francesca Tang1, Julie Paik2, Helen Tesfaye2, Heidi Zakoul2, Niklas Schmedt4, Lisette Koeneman5, Leo Seman6, Gary C Curhan2, Deborah J Wexler3, Elisabetta Patorno2 1Boehringer Ingelheim Pty Ltd, North Ryde, Sydney, New South Wales, Australia2Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA3Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA4Boehringer Ingelheim International GmbH, Ingelheim, Germany5Lilly Deutschland GmbH, Bad Homburg, Germany6Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, Connecticut, USA
Abstract
Aim
We investigated the association between empagliflozin use and the risk of nephrolithiasis in routine clinical care.
Background
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.
Methods
Using US 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 dipeptidyl peptidase 4 inhibitor (DPP4i), and 115,489 pairs initiating empagliflozin or a glucagon-like peptide 1 receptor agonist (GLP1RA). Our primary outcome was nephrolithiasis diagnosed by International Classification of Diseases codes in the inpatient or outpatient setting. We estimated hazard ratios (HRs), rate differences (RD) and 95% confidence intervals (CI), adjusting for >200 baseline covariates in the PS model.
Results
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 -6.2 [95%CI -7.6, -4.8]) and the GLP1RA group (HR 0.73 [95%CI 0.68-0.79]; RD -6.0 [95%CI -7.4, -4.6]). Secondary definitions of the nephrolithiasis outcome based on a hospital discharge diagnosis and procedures within 90 days of diagnosis produced consistent results.
Conclusions
In routine clinical care, empagliflozin use was associated with a reduced risk of nephrolithiasis, compared to DPP4i and GLP1RA use in patients with T2D.
Biography
Francesca is the Medical Lead for Diabetes and Chronic Kidney Disease at Boehringer Ingelheim Australia. She has a background in respiratory cellular biology and airway physiology before moving into cardio-renal-metabolic disease. Her current interests are in chronic kidney disease and health equity.