Author: María del Mar Prieto del Cura (Spain)
Co-authors: Maria Jose Crespo Carballes, Marina Sastre Ibañez, Laura Jimeno Anaya, Simon Quijada Angeli, Natalia Pastora Salvador, Jose García Hinojosa
Purpose
Vascular endothelial growth factor inhibitors (anti-VEGF) have been shown to be effective in the treatment of diabetic macular edema. However, there is little information about the systemic effects of intraocular administration of anti-VEGF drugs. This may be particularly important in patients with coexistent diabetic maculopathy and nephropathy because it can produce adverse renal effects, such as decreased glomerular filtration rate (eFGR), proteinuria, hypertension or thrombotic microangiopathy.
Setting/Venue
Hospital Universitario Infanta Leonor. Av. Gran Via del Este, 80, 28031 Madrid, Spain.
Methods
This retrospective cohort study analyzed the effect of intravitreal anti-VEGF drugs (bevacizumab, ranibizumab or aflibercept) on eFGR and microalbuminuria (MicA) in patients with diabetic macular edema and non-proliferative retinopathy without chronic kidney disease (CKD).
Results
66 patients were included, 54.5% male and 45.5% female, with a mean age of 66.70 +/-11.6 years. 80.3% were hypertensive and with 15.05+/-7.79 years of diabetes evolution. The mean follow-up of patients with antiangiogenic treatment was 42.5+/-28.07 months. The mean number of injections was 10.91+/-7.54; 57.6% received bevacizumab; 9.1% aflibercept, and 33.3% a combination (bevacizumab and ranibizumab or aflibercept). In 12.1% of the cases there was a worsening of the glomerular filtration rate (eFGR) and a 19.7% worsening of the microalbuminuria (MicA). The number of injections was not related to the worsening of the eFGR (p = 0.74) or the MicA (p = 0.239). No relationship was found between the type of drug and the deterioration of the GFR (p = 0.689) or the MicA (p = 0.53).
Conlusions
Based on the results there is a small proportion of patients with increase in MicA and the decrease in eFGR after anti-VEGF therapy. There was no association between the number of injection or the drug type in worsening of eFGR or MicA, although bevazicumab was the main anti-VEGF drugs administrated. Ophthalmologists should be aware of this effect, particularly for those patients with diabetic CKD in order to do a close monitoring of renal function and proteinuria after intravitreal administration of anti-VEGF and to be able to establish an early diagnosis of possible complications.
Financial Disclosure
None
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