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

Autor:	Bunge CC; Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Dalal PJ; Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Gray E; Northwestern University Feinberg School of Medicine, Biostatistics Collaboration Center, Chicago, Illinois., Culler K; Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Brown JJ; Division of Nephrology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois., Quaggin SE; Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Srivastava A; Division of Nephrology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois., Gill MK; Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Jazyk:	angličtina
Zdroj:	Ophthalmology science [Ophthalmol Sci] 2023 May 09; Vol. 3 (4), pp. 100326. Date of Electronic Publication: 2023 May 09 (Print Publication: 2023).
DOI:	10.1016/j.xops.2023.100326
Abstrakt:	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 m 2 ). 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 m 2 (HR, 1.86; 95% CI, 1.15-3.01), but not in individuals with baseline eGFR ≤ 30 ml/min/1.73 m 2 (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 Disclosures: Proprietary or commercial disclosure may be found after the references. (© 2023 by the American Academy of Ophthalmology.)
Databáze:	MEDLINE
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