{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T19:17:45Z","timestamp":1790104665577,"version":"4.0.1"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["R01LM013771"],"award-info":[{"award-number":["R01LM013771"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["R01AG071018"],"award-info":[{"award-number":["R01AG071018"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2025,6]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Use of sodium-glucose transport protein-2 inhibitors (SGLT2i) compared with glucagon-like peptide-1 receptor agonists portends a greater risk of candida urinary tract infection (UTI), but no increased risk of noncandida UTI.<\/jats:p>\n <\/jats:list-item>\n \n Abnormal genitourinary pathology is a risk factor for noncandida UTI, but no additive risk was observed in those taking SGLT2i.<\/jats:p>\n <\/jats:list-item>\n \n SGLT2i initiation is associated with an additive larger risk of candida UTI in those with genitourinary tract abnormalities.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Although sodium-glucose transport protein-2 inhibitors (SGLT2i) possess multiple beneficial effects, the drugs are associated with genitourinary (GU) infections. We sought to define the precise relationship between SGLT2i exposure, types of urinary tract infections (UTIs), and clinical risk factors.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We used an incident user design with active comparator analysis to derive SGLT2i and glucagon-like peptide-1 receptor agonist (GLP1ra) user cohorts from US nationwide insurance claim data. We used both covariate-adjusted Cox models and Cox models with inverse probability of treatment weighting to investigate the risk of noncandida UTI and candida UTI after drug exposure. We compared the risk between SGLT2i and GLP1ra exposure in the general population and subpopulations with GU abnormalities.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n SGLT2i exposure compared with GLP1ra exposure was associated with a greater risk of candida UTI (all hazard ratios [HRs] \u22652.42 and all\n P<\/jats:italic>\n values < 0.001), but a lower risk of noncandida UTI (all HRs \u22640.91 and all\n P<\/jats:italic>\n values < 0.001). Prior GU abnormalities such as prior UTI, prior genital infection, GU malignancy, indwelling Foley, or other GU pathology were associated with greater risk of noncandida and\/or candida UTI (all adjusted HRs \u22651.26 and all\n P<\/jats:italic>\n values \u2264 0.002). However, no difference in comparative risk of SGLT2i to GLP1ra exposure for noncandida UTI was observed in these subpopulations. By contrast, an additive effect between SGLT2i exposure and several GU abnormalities was observed for candida UTI (all adjusted HRs \u22652.37 and all\n P<\/jats:italic>\n values < 0.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n SGLT2i exposure was associated with greater risk of candida UTI, but not noncandida UTI. SGLT2i to GLP1ra comparative risk of noncandida UTI did not differ in individuals with abnormal GU pathology compared with those without.<\/jats:p>\n <\/jats:sec>\n \n Podcast<\/jats:title>\n This article contains a podcast at https:\/\/www.asn-online.org\/media\/podcast\/CJASN\/2025_06_27_CJASNJune.20.6.6272.mp3<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.0000000687","type":"journal-article","created":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T12:00:37Z","timestamp":1744372837000},"page":"820-828","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":6,"title":["Risk of Urinary Tract Infections with Sodium-Glucose Transport Protein-2 Inhibitors in Subpopulations with Abnormal Genitourinary Pathology"],"prefix":"10.2215","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3673-7592","authenticated-orcid":false,"given":"Jing","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuedi","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0145-2968","authenticated-orcid":false,"given":"Yi","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4917-6173","authenticated-orcid":false,"given":"Jing","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3066-2876","authenticated-orcid":false,"given":"Michael T.","family":"Eadon","sequence":"additional","affiliation":[{"name":"Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengyue","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,4,11]]},"reference":[{"issue":"1","key":"B1-20250702","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2337\/dbi20-0040","article-title":"SGLT2 inhibition for CKD and cardiovascular disease in type 2 diabetes: report of a scientific workshop sponsored by the National Kidney Foundation","volume":"70","author":"Tuttle","year":"2021","journal-title":"Diabetes."},{"issue":"8","key":"B3-20250702","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1080\/14740338.2023.2288897","article-title":"Urinary tract infections and genital mycotic infections associated with SGLT-2 inhibitors: an analysis of the FDA adverse event reporting system","volume":"23","author":"Yang","year":"2024","journal-title":"Expert Opin Drug Saf."},{"issue":"1","key":"B4-20250702","doi-asserted-by":"crossref","first-page":"e00910","DOI":"10.1002\/prp2.910","article-title":"Risk of genital and urinary tract infections associated with SGLT-2 inhibitors as an add-on therapy to metformin in patients with type 2 diabetes mellitus: a retrospective cohort study in Korea","volume":"10","author":"Yang","year":"2022","journal-title":"Pharmacol Res Perspect."},{"issue":"12","key":"B5-20250702","first-page":"59","article-title":"The incidence and risk factors of urinary tract infection in patients with type 2 diabetes mellitus using SGLT2 inhibitors: a real-world observational study","volume":"9","author":"Uitrakul","year":"2022","journal-title":"Medicines (Basel)."},{"issue":"6","key":"B6-20250702","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1111\/dom.14353","article-title":"Sodium-glucose cotransporter-2 inhibitors and the risk of urinary tract infection among diabetic patients in Japan: target trial emulation using a nationwide administrative claims database","volume":"23","author":"Takeuchi","year":"2021","journal-title":"Diabetes Obes Metab."},{"issue":"1","key":"B7-20250702","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3810\/pgm.2014.01.2720","article-title":"Urinary tract infection in randomized phase III studies of canagliflozin, a sodium glucose co-transporter 2 inhibitor","volume":"126","author":"Nicolle","year":"2014","journal-title":"Postgrad Med."},{"issue":"1","key":"B8-20250702","doi-asserted-by":"crossref","first-page":"2824","DOI":"10.1038\/s41598-017-02733-w","article-title":"Effects of SGLT2 inhibitors on UTIs and genital infections in type 2 diabetes mellitus: a systematic review and meta-analysis","volume":"7","author":"Liu","year":"2017","journal-title":"Sci Rep."},{"issue":"3","key":"B9-20250702","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1111\/dom.12825","article-title":"Urinary tract and genital infections in patients with type 2 diabetes treated with sodium-glucose co-transporter 2 inhibitors: a meta-analysis of randomized controlled trials","volume":"19","author":"Li","year":"2017","journal-title":"Diabetes Obes Metab."},{"issue":"11","key":"B10-20250702","doi-asserted-by":"crossref","first-page":"2394","DOI":"10.1111\/dom.13820","article-title":"Sodium glucose cotransporter 2 inhibitors and risk of genital mycotic and urinary tract infection: a population-based study of older women and men with diabetes","volume":"21","author":"Lega","year":"2019","journal-title":"Diabetes Obes Metab."},{"issue":"3","key":"B11-20250702","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1111\/dom.14261","article-title":"Effectiveness and safety of sodium-glucose co-transporter-2 inhibitors compared with dipeptidyl peptidase-4 inhibitors in older adults with type 2 diabetes: a nationwide population-based study","volume":"23","author":"Han","year":"2021","journal-title":"Diabetes Obes Metab."},{"issue":"1","key":"B12-20250702","doi-asserted-by":"crossref","first-page":"e022577","DOI":"10.1136\/bmjopen-2018-022577","article-title":"Comparative safety of the sodium glucose co-transporter 2 (SGLT2) inhibitors: a systematic review and meta-analysis","volume":"9","author":"Donnan","year":"2019","journal-title":"BMJ Open."},{"issue":"2","key":"B13-20250702","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1111\/dom.13531","article-title":"Comparative risk of genital infections associated with sodium-glucose co-transporter-2 inhibitors","volume":"21","author":"Dave","year":"2019","journal-title":"Diabetes Obes Metab."},{"issue":"4","key":"B14-20250702","doi-asserted-by":"crossref","first-page":"248","DOI":"10.7326\/M18-3136","article-title":"Sodium-glucose cotransporter-2 inhibitors and the risk for severe urinary tract infections: a population-based cohort study","volume":"171","author":"Dave","year":"2019","journal-title":"Ann Intern Med."},{"issue":"4","key":"B15-20250702","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1007\/s13300-021-01004-2","article-title":"Sodium-glucose Co-transporter 2 inhibitors (SGLT2i) exposure and outcomes in type 2 diabetes: a systematic review of population-based observational studies","volume":"12","author":"Caparrotta","year":"2021","journal-title":"Diabetes Ther."},{"issue":"9","key":"B16-20250702","doi-asserted-by":"crossref","first-page":"e023811","DOI":"10.1161\/JAHA.121.023811","article-title":"National trends in use of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists by cardiologists and other specialties, 2015 to 2020","volume":"11","author":"Adhikari","year":"2022","journal-title":"J Am Heart Assoc."},{"issue":"5","key":"B17-20250702","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1007\/s11892-024-01537-3","article-title":"Diabetes, SGLT-2 inhibitors, and urinary tract infection: a review","volume":"24","author":"Pishdad","year":"2024","journal-title":"Curr Diab Rep."},{"issue":"2","key":"B18-20250702","first-page":"187","volume":"34","journal-title":"J Royal Stat Soc. Series B (Methodological)"},{"issue":"12","key":"B19-20250702","doi-asserted-by":"crossref","first-page":"3075","DOI":"10.2337\/dci22-0027","article-title":"Diabetes management in chronic kidney disease: a consensus report by the American Diabetes Association (ADA) and Kidney Disease: Improving Global Outcomes (KDIGO)","volume":"45","author":"de Boer","year":"2022","journal-title":"Diabetes Care."},{"key":"B20-20250702","doi-asserted-by":"crossref","first-page":"1756287218814382","DOI":"10.1177\/1756287218814382","article-title":"Risk factors and predisposing conditions for urinary tract infection","volume":"11","author":"Storme","year":"2019","journal-title":"Ther Adv Urol."},{"issue":"15","key":"B21-20250702","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1056\/NEJMoa2024816","article-title":"Dapagliflozin in patients with chronic kidney disease","volume":"383","author":"Heerspink","year":"2020","journal-title":"N Engl J Med."},{"issue":"7","key":"B22-20250702","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1056\/NEJMoa1611925","article-title":"Canagliflozin and cardiovascular and renal events in type 2 diabetes","volume":"377","author":"Neal","year":"2017","journal-title":"N Engl J Med."},{"issue":"2","key":"B23-20250702","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1056\/NEJMoa2204233","article-title":"Empagliflozin in patients with chronic kidney disease","volume":"388","author":"Herrington","year":"2023","journal-title":"N Engl J Med."},{"issue":"5","key":"B24-20250702","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1177\/08971900241229107","article-title":"Risk of urinary infections in veterans on empagliflozin with concurrent catheter use","volume":"37","author":"Hopper","year":"2024","journal-title":"J Pharm Pract."},{"issue":"8","key":"B25-20250702","doi-asserted-by":"crossref","first-page":"3403","DOI":"10.1111\/dom.15682","article-title":"Comparative safety and cardiovascular effectiveness of sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists in nursing homes","volume":"26","author":"Riester","year":"2024","journal-title":"Diabetes Obes Metab."}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000000687","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:36:54Z","timestamp":1786369014000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000000687"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,11]]},"references-count":24,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.0000000687","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,11]]},"assertion":[{"value":"2024-09-15","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-08","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}