EFFECT OF INTRAVITREAL BEVACIZUMAB ON RENAL FUNCTION AND PROTEINURIA AMONG DIABETIC PATIENTS: A PROSPECTIVE OBSERVATIONAL STUDY IN NORTH INDIA

Introduction:

Intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents including Bevacizumab are first line therapy for proliferative diabetic retinopathy.

Intravitreal injection of bevacizumab is also absorbed systemically and decreases the plasma VEGF level to the significant amount up to one month after injection, which may leads renal consequences.

Critical gap in the literature pertains to effect intravitreal anti VEGF agents  on renal function and proteinuria consequences of these interventions

The aim is to study the effect of intravitreal injection of bevacizumab on the proteinuria and renal function in patients with diabetes mellitus (DM).

Methods:

Prospective observational study

Study period:  between Jan 2022 and Jan 2024

Patient with Type 2 DM with non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) and/or clinically significant DME (diabetic macular edema) receiving intravitreal injection of bevacizumab were included.

Patient with prior  history of  Intravitreal injection of anti-VEGF drugs within four months prior to the study and Intravenous administration of anti-VEGF drugs within 1 year were excluded. 

End-stage renal disease (receiving hemodialysis or eGFR <15 mL/min/1.73 m ) and transplant recipient patients were also excluded.

Patients were followed for 6 months with Urine ACR and Serum Creatinine.

Sample size: Total of 151 patients were screened, 50 patients were included in analysis after excluding patients not fulfilling eligibility criteria.

Statistical analysis - Numerical data: means and standard deviations (SDs), Categorical variables- percentage (%), Repeated measures ANOVA test (in normally distributed data) and Friedman test (in non-normally distributed data) were performed, Group comparison of continuous variable: Independent sample ‘t’ test, Wilcoxon-Mann-Whitney U Test and Kruskal Wallis Test.

Results:

The study revealed no significant change in eGFR, UACR, and UPCR at one month (p>0.05), but significant changes in these parameters were observed at six months (p<0.05). The subgroup with diabetic kidney disease (DKD) showed a significant risk of worsening eGFR, UACR, and UPCR compared to the non-DKD subgroup. However, the DKD subgroup exhibited higher proteinuria and lower eGFR at baseline. Baseline UPCR and UACR were predictors of worsening eGFR, UACR, and UPCR at six months.

Conclusions:

Patients with diabetic retinopathy who received intravitreal bevacizumab injections showed a non-significant change in renal function and proteinuria at one month, but a significant worsening of renal function and proteinuria at six months. Higher baseline UACR and UPCR were indicators of poor renal outcomes. 

However, further studies with a control group are required to confirm the independent effect of intravitreal bevacizumab on renal function and proteinuria.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.