A Rise in Kidney Stones in GLP-1 Users and Those with Metabolic Syndrome
July 6, 2026
The risk of kidney stone formation continues to rise in the general population, especially since the COVID pandemic. Increased prevalence of metabolic syndrome is the single most associated cause. Metabolic syndrome is diagnosed when a person has at least three of the following five conditions:
- Abdominal obesity
- High blood pressure
- Elevated fasting blood sugar
- High triglycerides
- Low HDL cholesterol
You may be concerned about the risk of kidney stone formation if you have metabolic syndrome and are using GLP-1 receptor agonist, so take this deep dive into safe usage of GLP-1s and stone prevention.
GLP-1 Agonists and Kidney Stones: Understanding the Risks and Benefits
GLP-1 receptor agonists have transformed modern medicine in treating obesity, type 2 diabetes mellitus and metabolic syndrome. They have demonstrated impressive benefits for blood sugar control, cardiovascular risks and weight loss. Despite their popularity, GLP-1 agonists may contribute to the risk of kidney stone formation in some patients, particularly during the initial phases of treatment, but their long-term metabolic benefits may reduce stone risk over time.
Why GLP-1 Agonists May Increase Kidney Stone Risk
The primary mechanism linking GLP-1 agonists to kidney stones is dehydration. GLP-1 agonists commonly cause gastrointestinal side effects:
- Nausea
- Vomiting
- Decreased appetite
- Diarrhea (occasionally)
These side effects can lead to dehydration. With the desire to eat and drink less, your fluid intake can be compromised. Your urine may become more concentrated, leading to a higher concentration of stone forming substances, such as calcium, oxalate and uric acid. These substances are more likely to crystallize in concentrated urine, leading to increased risk of stone formation. In fact, this concentrated urine environment is one of the strongest risk factors for kidney stone formation.
In addition, rapid weight loss may also transiently alter chemistry in some people, potentially increasing the risk of stone formation during periods of active weight reduction.
The Long-Term Metabolic Benefits
Although in the short term, dehydration may increase stone risk, the broader metabolic effects of GLP-1 agonists may have the opposite effect over the long run.
If you have metabolic syndrome, you likely already have urinary risk factors, including abnormal urine pH and low citrate levels, which can promote stone formation. By improving insulin sensitivity, blood glucose control, blood pressure and overall metabolic health, GLP-1 agonists may help address several underlying drivers of kidney stone disease. Improvements in metabolic syndrome may ultimately lower your likelihood of recurrent stone formation, especially uric acid stones which are a less common type of stone compared to calcium oxalate and calcium phosphate stones.
Should Patients with Kidney Stones Avoid GLP-1 Agonists?
In most cases, we would not recommend you avoid GLP-1s. Also, the history of kidney stones alone should not automatically exclude a patient from receiving a GLP -1 agonist therapy. With obesity, prediabetes, diabetes mellitus type 2 or elevated cardiovascular risk the potential benefits of treatment often outweigh your possible increase in stone risk.
How to mitigate the risk of kidney stone formation with use of GLP-1 agonist?
If you have a history of kidney stones and start GLP-1 therapy, you should follow this guidance:
- Diligently pay attention to daily fluid intake.
- Watch for the signs of dehydration, especially during initial periods of nausea, if vomiting or decreasing fluid intake.
- Continue standard kidney stone prevention strategies recommended by your health care team.
- Undergo appropriate metabolic stone evaluation when indicated.
- Consider medical stone prevention if there is a higher risk of recurrent stone formation while treating metabolic syndrome with GLP- 1 agonist.
Practical Takeaways
GLP-1 receptor agonists may increase kidney stone risk primarily through dehydration and reduced fluid intake, particularly early in treatment. However, the benefits of improving obesity, insulin resistance and diabetes risk clearly outweigh the risk of stone formation. Rather than avoiding these medications, should focus on good hydration and other kidney stone prevention measures. As with many aspects of medicine, the goal is not simply to minimize one risk, but to balance risks and benefits in the context of your overall health.
Current clinical evidence does not clearly establish GLP-1 agonists as a direct cause of kidney stones. The discussion is best framed as a potential increased risk related to dehydration and rapid weight loss, balanced against the likely long-term benefits of improved metabolic health. We may have a better picture in the upcoming years once there is more research available to assess the safety of GLP -1 agents in patients with kidney stones.
About Shams Zia, MD
Dr. Shams Zia earned her undergraduate degree from St. Joseph’s Government College in Karachi, Pakistan. She attended medical school at Dow Medical College in Karachi, Pakistan. Her internship was completed at the Aga Khan University Hospital. She went on to complete a three-year residency at SUNY Upstate Medical University in Syracuse, NY, where she also served as chief resident. She completed a fellowship in the Department of Nephrology at Duke University Medical Center as well as serving as a clinical research fellow in Nephrology and Transplant with the Duke Clinical Research Institute. She currently serves as a clinical nephrologist and medical director of WakeMed Kidney Stone Center as well as a hospitalist at WakeMed hospitalist department.
For immediate assistance with kidney stone issues, call the WakeMed Kidney Stone Center on the Stone Phone: 919-350-ROCK (7625).