Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal AssociationFeb 10, 2026

Kidney and urinary tract cancer risks with SGLT2 inhibitors compared to GLP-1 receptor agonists in type 2 diabetes

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Feb 11, 2026

Abstract

Over a mean follow-up of 44.2 months, SGLT2 inhibitors were associated with a lower incidence of renal cell carcinoma and urothelial cell carcinoma compared to GLP-1 receptor agonists.

In a cohort of 294,664 patients with type 2 diabetes, SGLT2 inhibitors showed an incidence of renal cell carcinoma of 1.07 per 1000 patient-years.
The incidence of renal cell carcinoma with GLP-1 receptor agonists was 1.26 per 1000 patient-years.
The hazard ratio for renal cell carcinoma associated with SGLT2 inhibitors was 0.85, suggesting a potential lower risk compared to GLP-1 receptor agonists.
For urothelial cell carcinoma, the incidence was 0.89 per 1000 patient-years for SGLT2 inhibitors versus 1.05 per 1000 patient-years for GLP-1 receptor agonists.
The hazard ratio for urothelial cell carcinoma with SGLT2 inhibitors was also 0.85, indicating a similar trend in risk reduction.

Simplified

BACKGROUND: The cardiovascular and renal benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) are well established among patients with type 2 diabetes (T2D). However, comparative evidence regarding cancer risk remains limited.

METHODS: We compared the risk of renal cell carcinoma (RCC) and urothelial cell carcinoma (UCC), two malignancies with rising incidence and poor prognosis, in patients with T2D initiating SGLT2i vs GLP-1 RA. A new-user comparative cohort study with a target trial emulation framework was conducted using the TriNetX database from June 1, 2014, to May 31, 2024. We included adults with T2D who initiated SGLT2i and those who initiated GLP-1 RA. Patients were matched 1:1 using propensity scores based on age, sex, race, socioeconomic status, lifestyle factors, medical utilization, comorbidities, medications, and laboratory measurements. Outcomes were incident RCC and UCC, analyzed with Kaplan-Meier plots and Cox regression.

RESULTS: There were 294 664 patients in each group after matching, with 278 760 female individuals (47.3%), a mean age of 59.3 years, 377 312 White individuals (64.0%), 117 542 African American or Black individuals (20.0%), and 29 750 Asian individuals (5.1%). Over a mean follow-up of 44.2 months, SGLT2i use was associated with a lower incidence of RCC (1.07 vs 1.26 per 1000 patient-years; hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.79-0.92) and UCC (0.89 vs 1.05 per 1000 patient-years; HR, 0.85; 95% CI, 0.78-0.92) than GLP-1 RA use. Subgroup analyses stratified by demographics and comorbidities showed consistent results.

CONCLUSION: Based on the established cardiorenal benefits of both agents, our findings provide comparative safety and cancer risk data warranting further investigation.

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Kidney and urinary tract cancer risks with SGLT2 inhibitors compared to GLP-1 receptor agonists in type 2 diabetes

Abstract

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