Long-Term Change in Renal Function After Intravitreal Anti-VEGF Treatment for Diabetic Macular Edema: A 2-Year Retrospective Cohort Study

Yi-Chung Fang; Ivan Pochou Lai; Tso-Ting Lai; Ta-Ching Chen; Chang-Hao Yang; Tzyy-Chang Ho; Chung-May Yang; Yi-Ting Hsieh

doi:10.1007/s40123-023-00771-4

Long-Term Change in Renal Function After Intravitreal Anti-VEGF Treatment for Diabetic Macular Edema: A 2-Year Retrospective Cohort Study

Ophthalmol Ther. 2023 Dec;12(6):2977-2988. doi: 10.1007/s40123-023-00771-4. Epub 2023 Aug 17.

Authors

Yi-Chung Fang^{1

2}, Ivan Pochou Lai³, Tso-Ting Lai^{3

4}, Ta-Ching Chen^{3

4}, Chang-Hao Yang^{3

4}, Tzyy-Chang Ho^{3

4}, Chung-May Yang³, Yi-Ting Hsieh^{5

6}

Affiliations

¹ National Taiwan University Hospital, Taipei, Taiwan.
² Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
³ Department of Ophthalmology, National Taiwan University Hospital, 7 Zhongshan S. Rd., Zhongzheng Dist., Taipei, 10002, Taiwan.
⁴ College of Medicine, National Taiwan University, Taipei, Taiwan.
⁵ Department of Ophthalmology, National Taiwan University Hospital, 7 Zhongshan S. Rd., Zhongzheng Dist., Taipei, 10002, Taiwan. ythyth@ntuh.gov.tw.
⁶ College of Medicine, National Taiwan University, Taipei, Taiwan. ythyth@ntuh.gov.tw.

Abstract

Introduction: To investigate the longitudinal changes in renal function and associated factors after intravitreal anti-vascular endothelial growth factor (VEGF) administration in diabetic macular edema (DME).

Methods: A total of 108 patients who had received intravitreal ranibizumab or aflibercept for DME and had follow-up visits for at least 2 years in one hospital were retrospectively enrolled. The estimated glomerular filtration rate (eGFR) at baseline and during the follow-up period and receipt of any renal replacement therapy were recorded. Linear regression and Cox regression models were used to evaluate factors associated with eGFR decline and renal replacement therapy.

Results: After intravitreal anti-VEGF treatment, eGFR showed a mean decline of -10.4 ± 23.2% and -16.5 ± 26.4% at months 12 and 24, respectively. Patients in the eGFR > 120 mL/min and 15-30 mL/min groups had the greatest decline (-32.0 ± 20.6% and -37.4 ± 30.9%, respectively) while those in the 61-90 mL/min group had the smallest decline (-4.3 ± 19.7%) in eGFR after the 2-year treatment. One out of 52 patients (1.9%) receiving ranibizumab and five out of 56 patients (8.9%) receiving aflibercept started hemodialysis or peritoneal dialysis within the 2-year follow-up period (P = 0.21). Baseline eGFR correlated with renal replacement therapy after intravitreal anti-VEGF treatment (hazard ratio = 0.879 per increase of 1 in eGFR, P = 0.018).

Conclusions: In DME patients receiving intravitreal anti-VEGF treatment, a persistent decline in eGFR was observed during the 2-year treatment course. Patients with extremely high or low eGFR had greater eGFR decline, and those with poor baseline eGFR tended to require dialysis after intravitreal anti-VEGF treatment.

Keywords: Diabetic macular edema; Diabetic nephropathy; Diabetic retinopathy; Estimated glomerular filtration rate; Vascular endothelial growth factor.