# Do GLP-1 Drugs Cause Kidney Stones? Nobody Has Run That Comparison | This GLP No study compares GLP-1 users against untreated people for kidney stones | one 358,203-pair cohort put stones at 21.3 per 1,000 person-years against 14.9 on an SGLT2 inhibitor. Publisher: This GLP Editorial Team Canonical: https://thisglp.com/research/do-glp1-drugs-cause-kidney-stones Updated: 2026-09-17 Published: 2026-09-16 [← Research](https://thisglp.com/research) Evidence # Do GLP-1 Drugs Cause Kidney Stones? Nobody Has Run That Comparison Every published study ranks one diabetes drug against another. Stones ran at 21.3 per 1,000 person-years on a GLP-1 and 14.9 on an SGLT2 inhibitor. Neither figure is a risk. [This GLP Editorial Team](https://thisglp.com/about)September 20267 min readUpdated September 2026 Kidney stones per 1,000 person-years · 21.3 · GLP-1 arm · 14.9 · SGLT2 arm · 6.4 fewer · 358,203 matched pairs, median 192 days **Research, not medical advice.** This GLP is independent and educational. Nothing here is a substitute for individualized care from a licensed clinician, and reading it creates no doctor–patient relationship. Talk to your own provider before starting, stopping, or changing any medication, peptide, or therapy. See our [methodology](https://thisglp.com/methodology) and [terms](https://thisglp.com/terms). ## Key takeaways - No study has compared GLP-1 users against untreated people for kidney stones. The question has not been answered. - One 358,203-pair cohort put stones at 21.3 per 1,000 person-years on a GLP-1 and 14.9 on an SGLT2 inhibitor. - That is a hazard ratio of 0.69 in the SGLT2 arm's favor, and a difference of 6.4 events per 1,000 person-years. - The likely mechanism is urate. SGLT2 inhibitors push uric acid out in the urine and cut gout by 36%. - Tirzepatide lowers uric acid too, by up to 0.95 mg/dL over 72 weeks, and 72.7% of that tracked weight loss. Nobody has measured it. Every published comparison sets one diabetes drug against another. None follows an untreated group. The best evidence is a 358,203-pair cohort. In it, stones ran at 21.3 per 1,000 person-years on a GLP-1 and 14.9 on an SGLT2 inhibitor [\[1\]](https://thisglp.com/research/do-glp1-drugs-cause-kidney-stones#ref-1). That ranks two treatments. It does not price either against taking nothing, which is the same limit this site reads into [the glaucoma comparison](https://thisglp.com/research/do-glp1-drugs-cause-glaucoma). ## What the cohort measured Adults with commercial insurance were matched on starting either drug class. Median follow-up was 192 days. Nephrolithiasis came in at a hazard ratio of 0.69 (95% CI 0.67 to 0.72) for the SGLT2 arm. The rate difference was 6.4 fewer events per 1,000 person-years. A second comparison, against DPP4 inhibitors, ran 14.6 against 19.9 per 1,000 person-years. The hazard ratio there was 0.74 (95% CI 0.71 to 0.77). The association held across sex, race and ethnicity, chronic kidney disease history and obesity. Age changed it. Under 70 the reduction was larger. At 70 and over the hazard ratio was 0.85. A pooled figure describes nobody in particular. ## The direction of the claim This is a study about SGLT2 inhibitors. GLP-1 drugs are the yardstick, not the subject. What it supports is that SGLT2 use came with fewer stones than GLP-1 use. Reading it backwards turns a ranking into a risk estimate, which is the error set out in [the gout comparison](https://thisglp.com/research/do-glp1-drugs-cause-gout). Why the SGLT2 arm probably won SGLT2 inhibitors increase uric acid excretion in the urine. A population-based cohort found gout diagnosed 36% less often on them than on GLP-1 drugs, at a hazard ratio of 0.64 [\[2\]](https://thisglp.com/research/do-glp1-drugs-cause-kidney-stones#ref-2). Urate is a stone-forming substance and it also acidifies the urine, which favors stone formation. So the stone result and the gout result are probably one finding about urate handling, reported twice. ## What weight loss does to urate GLP-1 drugs lower uric acid as well, by a different route. In a post hoc analysis of SURMOUNT-1, serum uric acid fell 0.69, 0.92 and 0.95 mg/dL on the three tirzepatide doses [\[3\]](https://thisglp.com/research/do-glp1-drugs-cause-kidney-stones#ref-3). Placebo gave 0.18 mg/dL. A mediation analysis attributed 72.7% of the fall to weight loss. Weight loss is slower than a diuretic effect. Nothing in the 192-day cohort window would capture much of it. The two classes may therefore look further apart at six months than at three years. It is the same follow-up problem raised in [the uric acid analysis](https://thisglp.com/research/uric-acid-fell-and-most-of-it-was-weight). ## What would settle it A cohort with an untreated arm, followed for years rather than months. The kidney trials already run that long. FLOW followed people with chronic kidney disease and stopped early for benefit [\[4\]](https://thisglp.com/research/do-glp1-drugs-cause-kidney-stones#ref-4), and stones were not among its endpoints. Until somebody counts them, the honest answer stands: unmeasured. If stones are part of your history, put it in the intake. Whether a seller makes a clinician reachable is a separate question. Most publish nothing about it. [what sellers do not publish](https://thisglp.com/research/what-glp1-sellers-do-not-publish) counts how little. The list worth sending is in [questions they leave open](https://thisglp.com/tools/questions-they-leave-open). ## Frequently asked Do GLP-1 drugs cause kidney stones? This study cannot answer that. It compared two drug classes against each other with no untreated group, so it shows only that the SGLT2 arm had fewer stones than the GLP-1 arm. How big was the difference? 14.9 events per 1,000 person-years against 21.3, a hazard ratio of 0.69 (95% CI 0.67 to 0.72) and 6.4 fewer events per 1,000 person-years. Did age change it? Yes. The reduction was larger under 70. In adults 70 or older the hazard ratio was 0.85. ## Sources 1. \[1\] Paik JM, et al. (2024). Sodium-Glucose Cotransporter 2 Inhibitors and Nephrolithiasis Risk in Patients With Type 2 Diabetes JAMA Internal Medicine. [PMID 38285598](https://pubmed.ncbi.nlm.nih.gov/38285598/) 2. \[2\] Fralick M, et al. (2020). Assessing the Risk for Gout With Sodium-Glucose Cotransporter-2 Inhibitors in Patients With Type 2 Diabetes: A Population-Based Cohort Study Annals of Internal Medicine. [PMID 31931526](https://pubmed.ncbi.nlm.nih.gov/31931526/) 3. \[3\] Sattar N, Scilletta S, Stefanski A, Wang H, Daly JW, Linetzky B (2026). Tirzepatide and change in uric acid and its association with weight reduction: post hoc analyses of the SURMOUNT-1 randomised placebo-controlled trial Annals of the Rheumatic Diseases. [PMID 41198460](https://pubmed.ncbi.nlm.nih.gov/41198460/) 4. \[4\] Perkovic V, et al. (2024). Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes New England Journal of Medicine. [PMID 38785209](https://pubmed.ncbi.nlm.nih.gov/38785209/) ## Where to get it ### Best GLP-1 injections Every injectable seller we can verify, with the price each one publishes and an honest read of what the trials measured. [Compare providers →](https://thisglp.com/best/compounded-semaglutide) ## More in Evidence - [ 150 minutes · Weekly activity goal · 2 days · Muscle strengthening · Adapt · Symptoms and ability ### Exercise on Ozempic: Building Strength Without Ignoring Symptoms ](https://thisglp.com/research/exercise-on-ozempic) - [ STEP 1, semaglutide 2.4 mg vs placebo, % change at 68 weeks · LDL cholesterol · −2.5% vs +1.3% · Total cholesterol · −3.3% vs +0.1% · HDL cholesterol · +5.2% vs +1.4% · Triglycerides · −21.9% vs −7.3% · Wegovy label, Table 13. Adults without diabetes. Ozempic doses are lower. ### Does Ozempic Lower Cholesterol? 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