Effects of Ophthalmic Intravitreal Injection of Anti-VEGF on Renal Function in Diabetes Mellitus Patients

Abstract

Objective: To investigate the effects of ophthalmic intravitreal injection of anti-VEGF treatment on renal function in DM2 patients.

Methodology: This observation retrospective study was carried out in the Ophthalmology and Nephrology departments of Akbar Niazi Teaching Hospital, Islamabad, from February 2022 to February 2024. Total 100 patients of DM2, 50 patients received anti-VEGF treatment were included, both with and without chronic kidney disease (CKD). The progression of renal function was analyzed after the initiation of anti-VEGF treatment and in comparison, to a control group.

Results: The patients mean age was 69.3±9.6 years (ranging 51–85 years). The ratio of males to females was 1:1.3, with 56% (n=28) being males and 44% (n=22) being females. At 12-month mark, 75% of patients had CKD, mean decrease in estimated glomerular filtration rate (eGFR) of 20%. 26% of patients (n=13) experienced a reduction in eGFR of > 25%, while 10% of patients (n=5) had a reduction in eGFR of > 50%. By the 24-month mark, 85% of patients had developed CKD, with an average reduction in eGFR of 33.3%. The eGFR mean decline rate among patients underwent anti-VEGF was 10 ml/min/year, significant high than the 1.5 ml/min/year observed in the control group (p < 0.05). Following initial management, renal replacement was required for 20% of patients in the CKD group (n=6) in the follow up period (average duration of 21±11 months). The primary risk factors for dialysis requirement were age, baseline proteinuria, and the presence of preexisting CKD.

Conclusion: Ophthalmic anti-VEGF intravitreal for treatment is linked with an increased risk of CKD and accelerated progressive end stage kidney disease in individuals with preexisting CKD. Understanding the administration of these drugs is critical for managing progressive CKD and appropriately limiting their administration in specific patient populations.