Effect of Intravitreal Anti-Endothelial Growth Factor Agents on Renal Function in Patients With Diabetes Mellitus

Introduction: Intravitreal administration of vascular endothelial growth factor inhibitors (anti-VEGF) is the treatment of choice in retinal pathology associated with type 2 diabetes mellitus (DM2). We aimed to analyze the effect of intravitreal anti-VEGF administration on renal function in patients with DM2. Methods: This is a single -center retrospective and observational study of patients with DM2 with and without chronic kidney disease (CKD). We analyzed the evolution of renal function after anti-VEGF onset, compared with a control group. Results: We included 45 patients (55.6% male) who received anti-VEGF therapy. Mean age was 74.4 +/- 11.5 (50-91) years. These were compared with 45 patients with similar characteristics. After 12 months, 76.3% had CKD with a mean reduction in estimated glomerular filtration rate (eGFR) of 19.4%. Nine patients (20%) had a >25% reduction in eGFR, and 3 patients (6.7%) had a >50% reduction in GFR. At 24 months, 80% of patients had CKD with a mean eGFR decrease of 28%. The mean eGFR slope of patients who had received anti-VEGF treatment was 10 ml/min/year compared to 1.5 ml/min/year in the control group ( P < 0.05). After the first administration, 5 patients (17.2%) in the CKD group required renal replacement therapy during follow-up (mean time 22 +/- 12 months). Main risk factors for need of dialysis were age, presence of previous CKD, and baseline proteinuria. Conclusion: Intravitreal anti-VEGF administration is a risk factor for CKD and rapid progression to endstage kidney disease in patients with previous CKD. Knowing these drugs' implications is crucial to avoid CKD progression and opportunely limit their use in certain patients.