Changes of Estimated Glomerular Filtration Rate and Glycated Hemoglobin A1c in Diabetic Macular Edema Patients Treated by Ranibizumab and Aflibercept in the Tertiary Referral Hospital

Abstract

Background and Objectives: Intravitreal injections (IVI) of vascular endothelial growth factor (VEGF) inhibitors are guideline-indicated treatments for diabetic macular edema (DME). However, some recent data have suggested that IVI VEGF inhibitors might, through systemic absorption, lead to a reduction in renal function. Our study aims to compare changes in glycated hemoglobin A1c (HbA1c) and estimated glomerular filtration rate (eGFR) between patients who received IVI ranibizumab and aflibercept treatment and patients who have not received IVI treatments. Materials and Methods: There were 17,165 DME patients with documented ophthalmology visits in the China Medical University Hospital-Clinical Research Data Repository. Those with a history of ESRD or bevacizumab treatment history, and those with missing information on HbA1c or eGFR, were excluded. After matching by age (±2 years), gender, and the year of clinical visit, 154 patients with medical treatment (including ranibizumab and aflibercept) and 154 patients without medical treatment were included in the study. The difference between HbA1c and eGFR at baseline and 3 and 12 months after the index date between the two groups was assessed. Results: Mean HbA1c and eGFR decreased between baseline and 12 months after the index date in both groups (p < 0.05). Compared with the non-treatment group, the treatment group had significantly lower HbA1c 3 and 12 months after the index date. There was no significant difference in eGFR between the two groups. In the generalized estimating equations (GEE) model, HbA1c in the treatment group was lower than the non-treatment group (−0.44%, 95% CI = −0.75, −0.14), but eGFR was similar after adjusting for age, gender, and index-year. HbA1c and eGFR decreased with the time in the adjusted GEE model (p < 0.0001) in both groups. Conclusions: This study showed that eGFR decreased with age and time and was not related to IVI anti-VEGF treatments in our tertiary referral hospital. IVI anti-VEGF therapy was also associated with better HbA1c control. It is suggested that DME patients can receive intravitreal VEGF inhibitors without inducing more renal impairment.

Recommendations for diabetic macular edema management by retina specialists and large language model-based artificial intelligence platforms

“…VEGF inhibitors may have nephrotoxic effects, according to emerging evidence [ 56 ]. However, a recent study published by Ku et al found no correlation between the use of intravitreal antiVEGF injections and a decrease in estimated glomerular filtration rate [ 57 ]. Several DME treatment guidelines recommend identifying the cause of hypertension and controlling it before beginning treatment with intravitreal antiVEGF injections [ 8 , 9 , 12 , 13 ].…”

Evaluation of the Relationship Between Diabetic Macular Edema and Renal Function in a Latino Population

“…In accordance with previously published results, in this sample of Latino patients with T2DM and DME, we did not find significant correlations between eGFR and OCT parameters (CMT or TMV, p > 0.05). In addition to comparisons among Latinos in several studies, contradictory results were found in those comparing Latinos to non-Hispanic whites [ 2 , 8 , 30 ]. However, the data consistently confirm the high rates of DR observed among Latinos of primarily Mexican ancestry [ 8 ].…”

“…Diabetes mellitus (DM) is a metabolic disorder characterized by the presence of chronic hyperglycemia, associated with long-term damage of different organs, particularly the eyes, kidneys, peripherical nervous system, heart, and blood vessels [ 1 , 2 ]. Diabetes can be classified into type 1 diabetes; type 2 diabetes, which appears to be due to a non-autoimmune progressive loss of adequate β-cell insulin secretion; and specific types of diabetes due to other causes or gestational diabetes mellitus [ 3 ].…”

“…The severity of vascular leakage in DME correlates with the level of VEGF produced and therefore anti-VEGF agents, such as ranibizumab (Lucentis, Genentech Inc., South San Francisco, CA, USA), bevacizumab (Avastin, Genentech Inc, South San Francisco, CA, USA), PRO-169 (anti-VEGF monoclonal antibody for intravitreal administration, Laboratorios Sophia, S.A. de C.V., Zapopan, Jalisco, Mexico), are used to inhibit it [ 9 – 12 ]. Nevertheless, it has been suggested that the use of anti-VEGF agents may result in systemic absorption, leading to further reduction in plasma VEGF activity, which turn produces accelerated hypertension, worsening proteinuria, glomerular disease, and possible chronic renal function decline [ 2 , 13 ].…”