Table 3.
Summary of studies assessing renal safety of intravitreal anti-VEGF agents
| Author, year | Study type | Anti-VEGF agent(s) | Key results | Inference |
|---|---|---|---|---|
| Bagheri et al. 2018 [37] | Prospective observational study of 40 patients with diabetic nephropathy and PDR and/or significant DME | Bevacizumab | ↑ Diastolic BP at 1 month (p = 0.002); no significant change in ACR, serum creatinine, or eGFR at 1 month | Bevacizumab not associated with renal dysfunction or proteinuria in diabetic nephropathy patients |
| Glassman et al. 2018 [38] | Secondary analysis of Protocol T (DRCR.net), 660 DME patients | Bevacizumab, ranibizumab, aflibercept | No significant changes in mean arterial pressure or UACR among groups at 1–2 years | No difference in renal impact between agents |
| Neill et al. 2019 [39] | Retrospective review over 2.6 years, assessing eGFR and ACR trends in patients with DME receiving multiple injections | Ranibizumab, aflibercept | Mean of 26.8 injections per patient; no association between injection frequency and eGFR/ACR change | Long-term VEGF inhibition not associated with progressive renal impairment |
| Yang et al. 2022 [40] | Retrospective review (2000–2017); anti-VEGF versus non-injection group with same retinal diagnoses | Ranibizumab, aflibercept | ↑ Dialysis risk in anti-VEGF users, especially those treated for DME | Anti-VEGF may increase dialysis risk, particularly in DME |
| Chen et al. 2023 [41] | Retrospective review: patients > 20 years receiving versus not receiving injections | Ranibizumab | ↑ Risk of CKD in patients receiving Ranibizumab | Ranibizumab exposure is an independent CKD risk factor |
| Cai et al. 2024 [42] | Retrospective cohort of patients ≥ 18 years receiving 3 monthly anti-VEGF injections | Bevacizumab, ranibizumab, aflibercept | Kidney failure incidence: 742/100,000 person-years; no significant differences in hazard ratio between agents | Risk of kidney failure present; no preference among agents based on current evidence |
| Bunge et al. 2024 [43] | Retrospective study of patients with PDR or DME receiving anti-VEGF versus controls | Bevacizumab, ranibizumab, aflibercept | No overall ↑ kidney risk; ↑ risk in patients with baseline eGFR > 30 mL/min/1.73 m [2] (HR: 1.86); > 12 injections not associated with decline | Anti-VEGF generally safe for kidney function, though caution advised in some subgroups |
Abbreviations: VEGF vascular endothelial growth factor, DME diabetic macular edema, PDR proliferative diabetic retinopathy, BP blood pressure, eGFR estimated glomerular filtration rate, ACR albumin–creatinine ratio, UACR urine albumin–creatinine ratio, CKD chronic kidney disease, HRhazard ratio, CI confidence interval