Evaluation of long-term intravitreal anti-vascular endothelial growth factor injections on renal function in patients with and without diabetic kidney disease

• Published in: BMC nephrology 2019-12, Vol.20 (1), p.478-7, Article 478
• Main Authors: O'Neill, Rachael Ann, Gallagher, Patrick, Douglas, Tricia, Little, Julie-Anne, Maxwell, Alexander Peter, Silvestri, Giuliana, McKay, Gareth
• Format: Article
• Language: English
• Subjects: Aflibercept; Aged; Albumin; Analysis; Angiogenesis Inhibitors - administration & dosage; Bevacizumab; Cerebrovascular diseases; Cohort Studies; Creatinine; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Diabetic macular oedema; Diabetic Nephropathies - blood; Diabetic Nephropathies - drug therapy; Diabetic nephropathy; Diabetic retinopathy; Diabetics; Edema; Electronic records; Endothelial growth factors; Epidermal growth factor receptors; Female; Glomerular Filtration Barrier; Glomerular filtration rate; Humans; Hypertension; Injection; Intravitreal anti-vascular endothelial growth factor; Intravitreal Injections - adverse effects; Intravitreal Injections - methods; Kidney diseases; Macular Edema - blood; Macular Edema - drug therapy; Male; Molecular weight; Morbidity; Nephrology; Patients; Ranibizumab; Ranibizumab - administration & dosage; Ranibizumab - blood; Receptors, Vascular Endothelial Growth Factor - administration & dosage; Receptors, Vascular Endothelial Growth Factor - blood; Recombinant Fusion Proteins - administration & dosage; Recombinant Fusion Proteins - blood; Regression analysis; Renal function; Retrospective Studies; Studies; Type 2 diabetes; Urine; Values; Vascular endothelial growth factor; Vascular Endothelial Growth Factor A - antagonists & inhibitors; Vascular Endothelial Growth Factor A - blood
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-019-1650-1

Administering anti-vascular endothelial growth factor (anti-VEGF) by intraocular injection has been shown to have a safe systemic profile. Nevertheless, incidents of acute kidney injury following anti-VEGF injection have been reported. We assessed the long-term effect of multiple intravitreal anti-VEGF injections on measures of renal function in patients with diabetes including rate of change of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (ACR). A retrospective review of patients receiving diabetic macular oedema (DMO) treatment was undertaken. Serum creatinine, ACR, number of intravitreal anti-VEGF injections and clinical characteristics were collected from electronic healthcare records (EHR). A co-efficient of eGFR and ACR change with time was calculated over a mean duration of 2.6 years. Regression modelling was used to assess variation in the number of anti-VEGF injections and change in eGFR and ACR. The EHR of 85 patients with DMO (59% male, 78% type 2 diabetes mellitus [T2DM]) were reviewed. On average, 26.8 intravitreal anti-VEGF injections were given per patient over a mean duration of 31 months. No association between increasing number of anti-VEGF injections and rate of eGFR decline (beta = 0.04, 95% confidence intervals [CI]: - 0.02, 0.09; p = 0.22) or ACR change over time (beta = 0.02, CI: - 0.19, 0.23; p = 0.86) was detected, following adjustment for hypertension, cerebrovascular disease, T2DM, and medications taken. Our data suggests regular long-term intravitreal VEGF inhibition does not significantly alter the rate of change in eGFR and/or ACR with increasing number of treatment injections.