EPH21 Real-world evidence of adverse kidney outcomes for intravitreal use of vascular endothelial growth factor (VEGF) inhibitors among patients with diabetic retinopathy

Objective: Studies of kidney injury following use of intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections among patients with diabetic retinopathy have mixed results and are limited by sample size and study design. Our objective was to determine whether intravitreal use of anti-VEGF agents was associated with adverse kidney outcomes compared to treatment with traditional laser photocoagulations. Methods: Adult patients with diabetic retinopathy and use of intravitreal anti-VEGF injections or laser photocoagulation were identified from January 2011, through December 2020 in large nationally representative database of administrative and electronic health record information for commercially insured and Medicare/Medicaid Advantage patients. Outcomes assessed included diagnosis of new chronic kidney disease (CKD), worsening CKD, and a composite endpoint of hospitalization or death using survival analyses. We applied inverse probability treatment weighting using propensity scores and adjusted for demographics, comorbidities, CKD stages at baseline and number of antidiabetic medications. Results: A total of 2,566 patients met the inclusion criteria, with 1,392 patients receiving intravitreal anti-VEGF injections and 1,174 patients receiving laser photocoagulation. Patients in the anti-VEGF group had a 33% higher hazard for newly developed CKD compared to patients in the laser group after adjustment (95% CI: 1.10, 1.60). There was no significant difference in worsening of pre-existing CKD in these two groups (HR=0.93; 95% CI: 0.77, 1.33). Patients treated with intravitreal antiVEGF injections had significantly higher hazards for hospitalizations and mortality compared to those treated with laser photocoagulation (HR=1.17; 95% CI: 1.04, 1.31). Conclusions: While use of anti-VEGF intravitreal injections was not associated with worsening CKD compared to laser photocoagulation, patients without pre-existing CKD had a higher risk of developing newly diagnosed CKD. These results continue to question the effects anti-VEGF injections have on adverse kidney outcomes.

• Autores: Chen, NC; Kane-Gill, S; Suh, K
• Tipo de recurso: Article of investigation
• Fecha de publicación: 2022
• Institución: Corporación Universidad de la Costa
• Repositorio: REDICUC - Repositorio CUC
• Idioma: eng
• OAI Identifier: oai:repositorio.cuc.edu.co:11323/10722
• Acceso en línea: https://hdl.handle.net/11323/10722; https://repositorio.cuc.edu.co/
• Palabra clave: Diabetic retinopathy; Vascular Endothelial Growth Factor (VEGF); Kidney
• Rights: embargoedAccess
• License: Atribución-NoComercial-SinDerivadas 4.0 Internacional (CC BY-NC-ND 4.0)