The Association of Intravitreal Anti-VEGF Injections With Kidney Function in Diabetic Retinopathy.

Content Provider	Europe PMC
Author	Bunge, Casey C. Dalal, Prarthana J. Gray, Elizabeth Culler, Kasen Brown, Julia J. Quaggin, Susan E. Srivastava, Anand Gill, Manjot K.
Copyright Year	2023
Abstract	PurposeTo examine whether patients with diabetic retinopathy receiving intravitreal anti-VEGF injections are at increased risk of kidney function decline.DesignRetrospective cohort study.ParticipantsIncluded 187 patients who received intravitreal anti-VEGF injections for proliferative diabetic retinopathy (PDR) and/or diabetic macular edema (DME), and 929 controls with non-PDR who did not receive injections, at a large tertiary care center in Chicago, Illinois.MethodsWe queried our institutional enterprise data warehouse to identify patients with diabetic retinopathy, determined whether they received intravitreal anti-VEGF injections, and followed kidney function for all patients over time.Main Outcome MeasuresWe assessed time to sustained 40% decline in estimated glomerular filtration rate (eGFR) from baseline in patients receiving intravitreal anti-VEGF injections and compared it with controls using Kaplan-Meier and multivariable adjusted Cox proportional hazards regression models.ResultsThis study included 1116 patients (565 female [50.6%]; mean [standard deviation {SD}] age, 57.3 [13.6] years; mean [SD] eGFR, 65.3 [32.1] ml/min/1.73 m2). Of these, 187 patients received ≥ 1 intravitreal anti-VEGF injection (mean [SD], 11.4 [13.1] injections) for PDR and/or DME, and 929 controls with non-PDR received no injections. Intravitreal anti-VEGF injection use was not associated with an increased risk of kidney function decline (hazard ratio [HR], 1.44; 95% confidence interval [CI], 0.97–2.15). Subgroup analyses revealed that use of intravitreal anti-VEGF injections was associated with increased risk of kidney function decline in male patients (HR, 1.87; 95% CI, 1.11–3.14) but not female patients (HR, 0.97; 95% CI, 0.50–1.89). Intravitreal anti-VEGF injection use was also associated with an increased risk of kidney function decline in patients with baseline eGFR > 30 ml/min/1.73 m2 (HR, 1.86; 95% CI, 1.15–3.01), but not in individuals with baseline eGFR ≤ 30 ml/min/1.73 m2 (HR, 0.97; 95% CI, 0.45–2.10). Among patients who received injections, receiving ≥ 12 injections was not associated with risk of kidney function decline (HR, 1.13; 95% CI, 0.52–2.49).ConclusionsIntravitreal anti-VEGF injections for patients with diabetic retinopathy are overall well-tolerated with respect to kidney function, but the use of intravitreal anti-VEGF injections was associated with an increased risk of kidney function decline in certain subgroups of patients.Financial Disclosure(s)Proprietary or commercial disclosure may be found after the references.
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Journal	Ophthalmology Science [Ophthalmol Sci]
Volume Number	3
DOI	10.1016/j.xops.2023.100326
PubMed Central reference number	PMC10336189
Issue Number	4
PubMed reference number	37449049
e-ISSN	26669145
Language	English
Publisher	Elsevier
Publisher Date	2023-05-09
Access Restriction	Open
Rights License	This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). © 2023 by the American Academy of Ophthalmology.
Subject Keyword	diabetic retinopathy diabetic macular edema intravitreal injections anti-vascular endothelial growth factor anti-VEGF
Content Type	Text
Resource Type	Article
Subject	Ophthalmology