Effects of intravitreal injections of anti-VEGF on long-term kidney function

Daniel Choi, MD, and colleagues at the University of Pennsylvania, Philadelphia, studied the effect of anti-vascular endothelial growth factor (VEGF) therapies in long-term patients and overall found no association between treatments and the risk of chronic kidney disease or end stage renal failure.

They pointed out that while intravitreal anti-VEGF can reduce VEGF without plasma, there is little information in the literature on the safety of long-term anti-VEGF intravitreal injections on the body and especially on the kidneys.

In this study, investigators used a commercial and Medicare Advantage medical claims database to identify patients who had been treated with an intravitreal anti-VEGF agent and the number of injections given over 4 years after the initial injection. . Patients who met the inclusion criteria were divided into quartiles based on the number of injections they received and the highest and lowest quartiles were compared.

The authors also looked at individual diseases, i.e., neovascular age-related macular degeneration (AMD), macular edema associated with retinal vein occlusion (RVO), and diabetic retinopathy (DR). They also used Cox proportional regression analysis to assess an increase every 5 injections in the risk of developing kidney disease, they described.

Analysis results

The results showed that 13,895 patients had received 1 to 3 injections of anti-VEGF (lower quartile) and 13,881 had received more than 21 or more injections (upper quartile).

In the lower and upper quartiles, respectively, patients with neovascular AMD received 6,228 injections (1 to 4 injections) and 6,172 received 24 or more injections (24 or more injections); those with macular edema due to RVO, 573 (1 to 2 injections) and 580 (12 or more injections); and those with DR, 523 (1 to 2 injections) and 517 (13 or more injections).

The authors reported that for patients in the highest quartile, the weighted analysis showed no overall association with the development of kidney disease (odds ratio [OR]1.00, 95% confidence interval [CI], 0.98-1.01, p=0.58) or in patients with neovascular AMD (OR, 0.99, 95% CI, 0.97-1.02, p=0.48), decreased risk of macular edema due to RVO (OR, 0.93, 95% CI, 0.86-0.99, p=0.04) and increased odds of DR (OR, 1.12 , 95% CI, 1.03-1.22, p=0.01). Cox analysis showed no association overall or for any subgroup (relative risk, 0.97-1.01, p>0.27 for all comparisons).

The authors concluded: “While logistic regression showed some association between increased number of injections and kidney disease, Cox’s analysis did not confirm these results, suggesting that time was a confounding factor. in logistic regression analysis.