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

Casey C. Bunge; Prarthana J. Dalal; Elizabeth Gray; Kasen Culler; Julia J. Brown; Susan E. Quaggin; Anand Srivastava; Manjot K. Gill

doi:10.1016/j.xops.2023.100326

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

Casey C. Bunge, Prarthana J. Dalal, Elizabeth Gray, Kasen Culler, Julia J. Brown, Susan E. Quaggin, Anand Srivastava, Manjot K. Gill^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

5 Scopus citations

Abstract

Purpose: To examine whether patients with diabetic retinopathy receiving intravitreal anti-VEGF injections are at increased risk of kidney function decline. Design: Retrospective cohort study. Participants: Included 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. Methods: We 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 Measures: We 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. Results: This 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). Conclusions: Intravitreal 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.

Original language	English (US)
Article number	100326
Journal	Ophthalmology Science
Volume	3
Issue number	4
DOIs	https://doi.org/10.1016/j.xops.2023.100326
State	Published - Dec 2023

Funding

This work was supported by a grant from the Illinois Society to Prevent Blindness, a VitreoRetinal Surgery Foundation Research Award, and an unrestricted grant from Research to Prevent Blindness. A.S. is supported by NIH grants K23DK120811 and U01AI163081, Kidney Precision Medicine Project Opportunity Pool grant under award U2CDK114886. S.E.Q. is supported by core resources from the George M. O'Brien Kidney Research Center at Northwestern University (NU-GoKIDNEY) P30DK114857. The funding organizations had no role in the design or conduct of this research. Obtained funding: N/A; Overall responsibility: Bunge, Dalal, Gray, Culler, Brown, Quaggin, Srivastava, Gill

Keywords

anti-VEGF
anti-vascular endothelial growth factor
diabetic macular edema
diabetic retinopathy
intravitreal injections

ASJC Scopus subject areas

Ophthalmology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.xops.2023.100326

Cite this

@article{9a3822279c4e45edb2f8f9b8fbeb06fd,

title = "The Association of Intravitreal Anti-VEGF Injections With Kidney Function in Diabetic Retinopathy",

abstract = "Purpose: To examine whether patients with diabetic retinopathy receiving intravitreal anti-VEGF injections are at increased risk of kidney function decline. Design: Retrospective cohort study. Participants: Included 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. Methods: We 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 Measures: We 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. Results: This 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). Conclusions: Intravitreal 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.",

keywords = "anti-VEGF, anti-vascular endothelial growth factor, diabetic macular edema, diabetic retinopathy, intravitreal injections",

author = "Bunge, {Casey C.} and Dalal, {Prarthana J.} and Elizabeth Gray and Kasen Culler and Brown, {Julia J.} and Quaggin, {Susan E.} and Anand Srivastava and Gill, {Manjot K.}",

note = "Funding Information: This work was supported by a grant from the Illinois Society to Prevent Blindness, a VitreoRetinal Surgery Foundation Research Award, and an unrestricted grant from Research to Prevent Blindness. A.S. is supported by NIH grants K23DK120811 and U01AI163081, Kidney Precision Medicine Project Opportunity Pool grant under award U2CDK114886. S.E.Q. is supported by core resources from the George M. O'Brien Kidney Research Center at Northwestern University (NU-GoKIDNEY) P30DK114857. The funding organizations had no role in the design or conduct of this research. Obtained funding: N/A; Overall responsibility: Bunge, Dalal, Gray, Culler, Brown, Quaggin, Srivastava, Gill Publisher Copyright: {\textcopyright} 2023 American Academy of Ophthalmology",

year = "2023",

month = dec,

doi = "10.1016/j.xops.2023.100326",

language = "English (US)",

volume = "3",

journal = "Ophthalmology Science",

issn = "2666-9145",

publisher = "Elsevier Inc.",

number = "4",

}

TY - JOUR

T1 - The Association of Intravitreal Anti-VEGF Injections With Kidney Function in Diabetic Retinopathy

AU - Bunge, Casey C.

AU - Dalal, Prarthana J.

AU - Gray, Elizabeth

AU - Culler, Kasen

AU - Brown, Julia J.

AU - Quaggin, Susan E.

AU - Srivastava, Anand

AU - Gill, Manjot K.

N1 - Funding Information: This work was supported by a grant from the Illinois Society to Prevent Blindness, a VitreoRetinal Surgery Foundation Research Award, and an unrestricted grant from Research to Prevent Blindness. A.S. is supported by NIH grants K23DK120811 and U01AI163081, Kidney Precision Medicine Project Opportunity Pool grant under award U2CDK114886. S.E.Q. is supported by core resources from the George M. O'Brien Kidney Research Center at Northwestern University (NU-GoKIDNEY) P30DK114857. The funding organizations had no role in the design or conduct of this research. Obtained funding: N/A; Overall responsibility: Bunge, Dalal, Gray, Culler, Brown, Quaggin, Srivastava, Gill Publisher Copyright: © 2023 American Academy of Ophthalmology

PY - 2023/12

Y1 - 2023/12

N2 - Purpose: To examine whether patients with diabetic retinopathy receiving intravitreal anti-VEGF injections are at increased risk of kidney function decline. Design: Retrospective cohort study. Participants: Included 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. Methods: We 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 Measures: We 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. Results: This 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). Conclusions: Intravitreal 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.

AB - Purpose: To examine whether patients with diabetic retinopathy receiving intravitreal anti-VEGF injections are at increased risk of kidney function decline. Design: Retrospective cohort study. Participants: Included 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. Methods: We 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 Measures: We 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. Results: This 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). Conclusions: Intravitreal 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.

KW - anti-VEGF

KW - anti-vascular endothelial growth factor

KW - diabetic macular edema

KW - diabetic retinopathy

KW - intravitreal injections

UR - http://www.scopus.com/inward/record.url?scp=85162260653&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85162260653&partnerID=8YFLogxK

U2 - 10.1016/j.xops.2023.100326

DO - 10.1016/j.xops.2023.100326

M3 - Article

C2 - 37449049

AN - SCOPUS:85162260653

SN - 2666-9145

VL - 3

JO - Ophthalmology Science

JF - Ophthalmology Science

IS - 4

M1 - 100326

ER -

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

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this