The effect of increasing number of intravitreal vascular endothelial growth factor inhibitor injections on the rate of renal function decline in patients with diabetic macular oedema

Patrick Gallagher, Tricia Douglas, Giuliana Silvestri, Julie-Anne Little, Gareth McKay

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Abstract

Purpose

Hypertension, proteinuria and renal thrombotic microangiopathy have occurred following intravenous administration of anti-vascular endothelial growth factor (anti-VEGF) in oncology. Intravitreal administration combined with a markedly reduced dose has given them a safe systemic profile in ophthalmology. However, renal safety must continue to be evaluated given their systemic exposure and reported cases of acute kidney injury following anti-VEGF injection. This audit aimed to assess the rate of estimated glomerular filtration rate (eGFR) decline rather than rely on detection of acute kidney injury or chronic kidney disease.

Methods

A retrospective audit was conducted of 92 patients receiving treatment for diabetic macular oedema (DMO). Serum creatinine measurements (to estimate eGFR), number and type of intravitreal anti-VEGF injections and potential confounding variables were collected from electronic healthcare records. An eGFR slope co-efficient based on eGFR measurements taken before; during and after the injection period was calculated. Linear regression modelling was used in an unadjusted and adjusted analysis, to assess if increasing number of intravitreal anti-VEGF injections were associated with a change in eGFR.

Results

A total of 92 patients with DMO, (57.6% male, 78.3% type 2 diabetes mellitus [T2DM]) were audited. The mean duration of diabetes was 16.1 years and mean HbA1c was 66.9 mmol/mol. There was a high prevalence of co-morbidities with 82.6%, 76.1% and 33.7% of patients having hypertension, hyperlipidaemia and chronic kidney disease, respectively.

On average, 26.9 intravitreal anti-VEGF injections were given per patient over a mean duration of 31 months. Renal function declined from a mean baseline eGFR of 75.4 ± 21.0 ml/min/1.73m2 to a follow up mean eGFR of 66.6 ± 22.7 ml/min/1.73m2. However, no association between increasing number of intra-vitreal anti-VEGF injections and eGFR slope was detected (beta = 0.035; p=0.206, confidence intervals [CI]: -0.2, 0.89), which remained non-significant following adjustment for hypertension, cerebrovascular disease and T2DM (beta = 0.036; p=0.198, CI: -0.019, 0.092).

Conclusion

This audit suggests regular long-term intravitreal VEGF inhibition does not significantly alter the rate of eGFR beyond that over natural decline. Further post-marketing trials assessing the long-term renal safety of intravitreal anti-VEGF injections particularly in high-risk groups are warranted.
Original languageEnglish
Title of host publicationXXIII Biennial Meeting of the International Society for Eye Research: Abstract Book
Publication statusPublished - 09 Sep 2018

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    Gallagher, P., Douglas, T., Silvestri, G., Little, J-A., & McKay, G. (2018). The effect of increasing number of intravitreal vascular endothelial growth factor inhibitor injections on the rate of renal function decline in patients with diabetic macular oedema. In XXIII Biennial Meeting of the International Society for Eye Research: Abstract Book