Bunge Casey C, Dalal Prarthana J, Gray Elizabeth, Culler Kasen, Brown Julia J, Quaggin Susan E, Srivastava Anand, Gill Manjot K
Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Northwestern University Feinberg School of Medicine, Biostatistics Collaboration Center, Chicago, Illinois.
Ophthalmol Sci. 2023 May 9;3(4):100326. doi: 10.1016/j.xops.2023.100326. eCollection 2023 Dec.
To examine whether patients with diabetic retinopathy receiving intravitreal anti-VEGF injections are at increased risk of kidney function decline.
Retrospective cohort study.
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.
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.
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.
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). 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 (HR, 1.86; 95% CI, 1.15-3.01), but not in individuals with baseline eGFR ≤ 30 ml/min/1.73 m (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).
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.
Proprietary or commercial disclosure may be found after the references.
探讨接受玻璃体内抗血管内皮生长因子（VEGF）注射的糖尿病视网膜病变患者肾功能下降风险是否增加。
回顾性队列研究。
纳入了伊利诺伊州芝加哥一家大型三级医疗中心的187例因增殖性糖尿病视网膜病变（PDR）和/或糖尿病性黄斑水肿（DME）接受玻璃体内抗VEGF注射的患者，以及929例未接受注射的非PDR对照患者。
我们查询了机构企业数据仓库以识别糖尿病视网膜病变患者，确定他们是否接受了玻璃体内抗VEGF注射，并随时间跟踪所有患者的肾功能。
我们评估了接受玻璃体内抗VEGF注射的患者估计肾小球滤过率（eGFR）从基线持续下降40%的时间，并使用Kaplan-Meier和多变量调整Cox比例风险回归模型将其与对照组进行比较。
本研究纳入了1116例患者（565例女性[50.6%]；平均[标准差{SD}]年龄，57.3[13.6]岁；平均[SD]eGFR，65.3[32.1]ml/min/1.73m²）。其中，187例患者因PDR和/或DME接受了≥1次玻璃体内抗VEGF注射（平均[SD]，11.4[13.1]次），929例非PDR对照患者未接受注射。玻璃体内抗VEGF注射的使用与肾功能下降风险增加无关（风险比[HR]，1.44；95%置信区间[CI]，0.97-2.15）。亚组分析显示，玻璃体内抗VEGF注射的使用与男性患者肾功能下降风险增加有关（HR，1.87；95%CI，1.11-3.14），但与女性患者无关（HR，0.97；95%CI，0.50-1.89）。玻璃体内抗VEGF注射的使用也与基线eGFR>30ml/min/1.73m²的患者肾功能下降风险增加有关（HR，1.86；95%CI，1.15-3.01），但与基线eGFR≤30ml/min/1.73m²的个体无关（HR，0.97；95%CI，0.45-2.10）。在接受注射的患者中，接受≥12次注射与肾功能下降风险无关（HR，1.13；95%CI，0.52-2.49）。
对于糖尿病视网膜病变患者，玻璃体内抗VEGF注射总体上对肾功能耐受性良好，但在某些亚组患者中，玻璃体内抗VEGF注射的使用与肾功能下降风险增加有关。
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