Renal function after intravitreal administration of vascular endothelial growth factor inhibitors in patients with diabetes and chronic kidney disease

Abstract

The present study aimed to determine whether intravitreal administration of vascular endothelial growth factor inhibitors is associated with deterioration of renal function, as seen with systemic administration, in patients with diabetes and chronic kidney disease. Estimated glomerular filtration rates before and after 160 intravitreal injections of vascular endothelial growth factor inhibitors (aflibercept, bevacizumab or ranibizumab) were compared in 69 patients with diabetes and with a baseline estimated glomerular filtration rate <60 mL/min/1.73 m2. We also determined the incidence of acute kidney injury. The data showed no significant difference in the estimated glomerular filtration rate before and after vascular endothelial growth factor inhibitor administration in all patients and in patient subgroups based on each inhibitor. Furthermore, no episodes of acute kidney injury occurred. In conclusion, intravitreal administration of vascular endothelial growth factor inhibitors is unlikely to be associated with a deterioration of renal function in patients with diabetes and chronic kidney disease.

Role of VEGF-A and LRG1 in Abnormal Angiogenesis Associated With Diabetic Nephropathy

“…In another study, diabetic patients accepted intravitreal anti-VEGF agents rapidly developed worsening proteinuria and renal function decline ( Hanna et al, 2019 ). On the contrary, a current study showed that the average eGFR did not change in a total of 69 diabetic patients who received intravitreal anti-VEGF agents ( Kameda et al, 2018 ). In addition, no episode of acute kidney injury occurred.…”

“…The VEGF-A inhibitors have previously shown some beneficial effects on diabetic ocular disease and DN experimental mice models, but recent evidences raised controversial opinions on its use in clinical practice. Several lines of evidence revealed that patients accepted anti-VEGF treatment developed worsening proteinuria and glomerular microangiopathy ( Hanna et al, 2019 ; Touzani et al, 2019 ), while other studies supported that it is unlikely to cause any renal injury ( Kameda et al, 2018 ; O’Neill et al, 2019 ). Leucine-richα-2-glycoprotein 1 (LRG1) is a novel pro-angiogenic factor that has demonstrated to promote angiogenesis by enhancing ALK-1signaling pathway in both diabetic ocular disease and DN mouse models ( Wang et al, 2013 ; Haku et al, 2018 ; Hong et al, 2019 ).…”

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

“…A retrospective study of renal safety following acute anti-VEGF exposure showed no significant change in mean eGFR and no episodes of acute kidney injury, following a single intravitreal anti-VEGF injection of ranibizumab, aflibercept or bevacizumab, in a cohort of 69 patients with DM and CKD [29]. However, the study by Kameda and colleagues did not consider the potential cumulative effects of intravitreal anti-VEGF exposure on renal function.…”

Nephrotoxicity induced by intravitreal vascular endothelial growth factor inhibitors: emerging evidence

“…70 A recent retrospective study of 69 patients did not report acute kidney injury after a short-term follow-up of 7 to 30 days after intravitreal injections of bevacizumab, aflibercept, or ranibizumab. 71 Levels of anti-VEGF agents and proteinuria were not monitored. This Japanese study also raised the possibility that differences in genetic background might modulate differences in renal toxicity among patients.…”