Long-term Anti-VEGF Therapy for Diabetic Macular Edema Linked to Declining Renal Function

Long-term treatment with intravitreal anti-vascular endothelial growth factor (VEGF) therapy may be associated with a continuous decline in estimated glomerular filtration rate (eGFR) in patients with diabetic macular edema (DME), according to a recent retrospective cohort study. This research published in Ophthalmology And Therapy discovered a mean eGFR decrease of 16.5% over a 2-year period. Patients with either extremely high or low eGFR values exhibited a more significant eGFR decline, with those starting with poor baseline rates often needing dialysis following anti-VEGF treatment.

DME is the leading cause of visual impairment in individuals with diabetes, characterized by the breakdown of the blood-retinal barrier. VEGF inhibitors have revolutionized the management of various eye conditions, including DME, by demonstrating anatomical and visual improvements. However, the impact of intravitreal anti-VEGF injections on renal function has not been thoroughly investigated. Given the frequent coexistence of diabetic nephropathy and diabetic retinopathy, it is important to consider longitudinal changes in eGFR following anti-VEGF treatment for DME.

The study, led by Dr. Yi-Ting Hsieh from the National Taiwan University Hospital, examined longitudinal alterations in renal function among patients receiving intravitreal ranibizumab or aflibercept for DME over a 2-year period.

The research included 108 patients retrospectively enrolled between January 2013 and December 2018. Baseline eGFR measurements were recorded, and follow-up measurements were taken throughout the 2-year treatment period. Additionally, any instances of renal replacement therapy, such as hemodialysis or renal transplantation, were documented.

During the treatment period, each patient received an average of 9.1 ± 3.9 injections during the first year and 2.6 ± 3.0 injections during the second year. Results revealed a consistent decline in eGFR among DME patients over the 2-year treatment period, with mean eGFR declines of –10.4% at month 12 and –16.5% at month 24 post-treatment.

The study identified that patients with extremely high or low eGFR values experienced the most significant eGFR declines, with the eGFR >120 mL/min and 16–30 mL/min groups displaying declines of –32.0% and –37.4%, respectively. In contrast, patients in the 61–90 mL/min group exhibited the smallest eGFR decline at –4.3% after 2 years of treatment.

Throughout the 2-year study period, 1 out of 52 patients (1.9%) receiving ranibizumab and 5 out of 56 patients (8.9%) receiving aflibercept initiated hemodialysis or peritoneal dialysis (P = .21). Regression analysis revealed a correlation between baseline eGFR and the need for renal replacement therapy following intravitreal anti-VEGF treatment (hazard ratio, 0.879 per 1-unit eGFR increase; P = .018).

This study represents a significant step in understanding the potential effects of long-term intravitreal anti-VEGF treatment on renal function in patients with DME. Further research is

needed to clarify these findings and identify strategies for monitoring and managing renal function in individuals requiring extended anti-VEGF therapy for DME.

Reference:

Fang YC, Lai IP, Lai TT, et al. Long-Term Change in Renal Function After Intravitreal Anti-VEGF Treatment for Diabetic Macular Edema: A 2-Year Retrospective Cohort Study [published online ahead of print, 2023 Aug 17]. Ophthalmol Ther. 2023;10.1007/s40123-023-00771-4. doi:10.1007/s40123-023-00771-4