Studies Detail Risk of Renal Damage Associated with Anti-VEGF Treatment

Results from two recent studies are providing insight into the risk of renal damage associated with intravitreal anti-vascular endothelial growth factor (VEGF) therapies in the treatment of retinal diseases, including age-related macular degeneration (AMD) and diabetic macular edema (DME).

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The first investigation analyzed the effect of intravitreal anti-VEGF agents on estimated glomerular filtration rate (eGFR) and microalbuminuria in patients with DME and nonproliferative retinopathy, without chronic kidney disease (CKD), in clinical practice.¹

Meanwhile, the other, a systematic review and meta-analysis of more than a dozen randomized clinical trials, analyzed associations between the use of intravitreal anti-VEGF agents and acute kidney injury risk.²

Risk of Renal Damage May Be Associated with Anti-VEGF Treatment

Most patients with diabetic macular edema (DME) do not experience kidney damage after treatment with anti-vascular endothelial growth factor (VEGF), according to new research.1

The analysis indicates a small proportion of study participants experienced an increase in microalbuminuria and a worsening of eGFR but found a lack of association between the number of injections or the drug type and renal damage.

“We did not find renal filtration or microalbuminuria deterioration in our series after intravitreal anti-VEGF therapy in diabetic patients, suggesting that this therapy is safe in terms of renal function even in diabetic patients,” wrote the investigative team, led by Mar Prieto del Cura, department of ophthalmology, Hospital Universitario Infanta Leonor.

This single-center retrospective cohort study analyzed the effect of intravitreal anti-VEGF agents (bevacizumab, ranibizumab, or aflibercept) on eGFR and microalbuminuria in patients with diabetes with DME and nonproliferative diabetic retinopathy. A total of 115 medical records of patients were reviewed between December 2019 and January 2021. Renal function worsening, due to eGFR and microalbuminuria, after VEGF inhibitor treatment was identified as the primary endpoint.

A total of 66 patients met inclusion criteria (45.5% female; mean age, 66.7 years) and were included in the analysis. The mean follow-up time for patients was 42.5 months and patients had a mean number of 10.91 injections.

Upon analysis, investigators found anti-VEGF treatment was not related to renal function deterioration. Data showed 12.1% of cases experienced eGFR worsening, while 19.7% experienced worsening of the microalbuminuria.

Analyses suggested the number of injections was not related to eGFR (P = .74) or microalbuminuria worsening (P = .239). There were additionally no identified relationships between the type of drug and deterioration of eGFR (P = .689) or microalbuminuria (P = .53).

However, patients with hypertension at baseline were more likely to experience worsening renal function after receiving anti-VEGF treatment, compared to non-hypertensive patients.

“These results may support the idea that patients with renal dysfunction may need to be followed closely after this therapy specifically in hypertensive patients,” investigators wrote.

Anti-VEGF Drugs Not Associated with Acute Kidney Injury Risk

Intravitreal anti-VEGF drugs were not associated with acute kidney injury risk, according to a new systematic review and meta-analysis of 13 randomized controlled trials.²

The lack of association remained regardless of anti-VEGF drug choice (aflibercept or ranibizumab), or retinal disease involved (age-related macular degeneration [AMD], diabetic retinopathy or DME, or retinal vein occlusion [RVO]).

Prior observational data have reported acute kidney injury stemming from intravitreal anti-VEGF drugs for retinal diseases. But there is a paucity of information on this topic from systemic reviews and meta-analyses of randomized controlled trials.

As a result, investigators from National Cheng Kung University, led by Jia-Horung Hung, aimed to evaluate acute kidney injury risk associated with intravitreal anti-VEGF drugs in patients with retinal diseases. The study team searched PubMed, Embase, and the Cochrane Register of Controlled Trials in July 2023. Of the 13 trials included in the analysis, 4 evaluated aflibercept and 9 evaluated ranibizumab, with a total of 4284 participants.

Upon analysis, investigators found intravitreal anti-VEGF drugs did not increase the acute kidney injury risk, compared with controls (odds ratio [OR], 1.00; 95% CI, 0.49 - 2.04). No difference in acute kidney injury risk was observed between different anti-VEGF drugs, including aflibercept (OR, 1.10; 95% CI, 0.27–4.43) and ranibizumab (OR, 4.61; 95% CI, 0.42–2.22).

According to the results, there were no differences between different retinal diseases, including AMD (OR, 4.61; 95% CI, 0.07 - 284.13), DME (OR, 0.90; 95% CI, 0.42 – 1.93), or RVO (OR, 1.57; 95% CI, 0.16 – 15.88).

References

1. del Cura, Mar Prieto; Carballés, María J C; Sastre-Ibáñez, Marina. Risk of renal damage associated with intravitreal anti-VEGF therapy for diabetic macular edema in routine clinical practice. Indian Journal of Ophthalmology 71(8):p 3091-3094, August 2023. | DOI: 10.4103/IJO.IJO_44_23
2. Tsao, YC., Chen, TY., Wang, LA. et al. Acute Kidney Injury from Intravitreal Anti-vascular Endothelial Growth Factor Drugs: A Systematic Review and Meta-analysis of Randomized Controlled Trials. BioDrugs (2023). https://doi.org/10.1007/s40259-023-00621-6