All patients receiving anti-VEGF injections face an increased risk of kidney injury or failure, uninfluenced by the specific medication being used. Photo: Leo Skorin, OD. Click image to enlarge.

While anti-VEGF therapy has the potential to stop vision deterioration in patients with blinding diseases, it doesn’t come without the potential of adverse effects. One that’s been heavily studied is kidney injury or failure, the risk of which is influenced by the level of systemic absorption from the intravitreal injections. Since studies have shown this characteristic varies by medication, researchers recently sought to compare the risk of kidney failure among patients with blinding diseases who received either ranibizumab, aflibercept or bevacizumab. Notably, their retrospective cohort study found no substantial difference between the relative risk for kidney failure in patients taking any of the three anti-VEGF drugs.

For the study, data was obtained from 12 databases in the Observational Health Data Sciences and Informatics network, including patients who were at least 18 years old and had received at least three monthly anti-VEGF injections to treat one of the following blinding diseases: diabetic retinopathy, diabetic macular edema, exudative age-related macular degeneration or retinal vein occlusion. Then, the researchers calculated the standardized incidence proportions and rates of kidney failure while receiving anti-VEGF treatment before stratifying the risk based on the specific medication.

Of more than six million patients from the databases, 37,189 received ranibizumab, 39,447 received aflibercept and 163,611 received bevacizumab. The incidence rate of kidney failure among those on anti-VEGF therapy was 743 per 100,000 person-years (range: 0 to 2,661). The standardized incidence proportion was 678 per 100,000 persons with kidney failure, which the researchers pointed out is higher than the overall population. When comparing the various anti-VEGF medications, the meta-analysis hazard ratios revealed no significantly different relative risk for kidney failure between those receiving ranibizumab, bevacizumab or aflibercept.

In their paper on the study in Ophthalmology Retina, the researchers advised based on their findings that eyecare providers “should be aware that patients needing intravitreal anti-VEGF medications are at high risk for kidney failure, particularly those with pre-existing kidney disease and impairment, and might benefit from ongoing kidney health monitoring.” They also concluded, “There is no evidence in this study to support the practice of preferentially selecting ranibizumab over aflibercept and bevacizumab to avoid inducing kidney failure in patients with blinding diseases.”