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Cited by 20Retinal Diseases and TreatmentsDrug-Induced Ocular ToxicityAcute Kidney Injury Research

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Similar Risk of Kidney Failure among Patients with Blinding Diseases Who Receive Ranibizumab, Aflibercept, and Bevacizumab

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Cai, Cindy X., Nishimura, Akihiko, Bowring, Mary G., Westlund, Erik, Tran, Diep, Ng, Jia H., Nagy, Paul, Cook, Michael, McLeggon, Jody-Ann, DuVall, Scott L., Matheny, Michael E., Golozar, Asieh, Ostropolets, Anna, Minty, Evan, Desai, Priya, Bu, Fan, Toy, Brian, Hribar, Michelle, Falconer, Thomas, Zhang, Linying, Lawrence-Archer, Laurence, Boland, Michael V., Goetz, Kerry, Hall, Nathan, Shoaibi, Azza, Reps, Jenna, Sena, Anthony G., Blacketer, Clair, Swerdel, Joel, Jhaveri, Kenar D., Lee, Edward, Gilbert, Zachary, Zeger, Scott L., Crews, Deidra C., Suchard, Marc A., Hripcsak, George, Ryan, Patrick B.·2024·Ophthalmology Retina
DOI 10.1016/j.oret.2024.03.014PMC PMC11298306
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Abstract

PURPOSE: To characterize the incidence of kidney failure associated with intravitreal anti-VEGF exposure; and compare the risk of kidney failure in patients treated with ranibizumab, aflibercept, or bevacizumab. DESIGN: Retrospective cohort study across 12 databases in the Observational Health Data Sciences and Informatics (OHDSI) network. SUBJECTS: Subjects aged ≥ 18 years with ≥ 3 monthly intravitreal anti-VEGF medications for a blinding disease (diabetic retinopathy, diabetic macular edema, exudative age-related macular degeneration, or retinal vein occlusion). METHODS: The standardized incidence proportions and rates of kidney failure while on treatment with anti-VEGF were calculated. For each comparison (e.g., aflibercept versus ranibizumab), patients from each group were matched 1:1 using propensity scores. Cox proportional hazards models were used to estimate the risk of kidney failure while on treatment. A random effects meta-analysis was performed to combine each database's hazard ratio (HR) estimate into a single network-wide estimate. MAIN OUTCOME MEASURES: Incidence of kidney failure while on anti-VEGF treatment, and time from cohort entry to kidney failure. RESULTS: Of the 6.1 million patients with blinding diseases, 37 189 who received ranibizumab, 39 447 aflibercept, and 163 611 bevacizumab were included; the total treatment exposure time was 161 724 person-years. The average standardized incidence proportion of kidney failure was 678 per 100 000 persons (range, 0-2389), and incidence rate 742 per 100 000 person-years (range, 0-2661). The meta-analysis HR of kidney failure comparing aflibercept with ranibizumab was 1.01 (95% confidence interval [CI], 0.70-1.47; P = 0.45), ranibizumab with bevacizumab 0.95 (95% CI, 0.68-1.32; P = 0.62), and aflibercept with bevacizumab 0.95 (95% CI, 0.65-1.39; P = 0.60). CONCLUSIONS: There was no substantially different relative risk of kidney failure between those who received ranibizumab, bevacizumab, or aflibercept. Practicing ophthalmologists and nephrologists should be aware of the risk of kidney failure among patients receiving intravitreal anti-VEGF medications and that there is little empirical evidence to preferentially choose among the specific intravitreal anti-VEGF agents. FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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Metadata

Authors
Cai, C. X., Nishimura, A., Bowring, M. G., Westlund, E., Tran, D., Ng, J. H., Nagy, P., Cook, M., McLeggon, J.-A., DuVall, S. L., Matheny, M. E., Golozar, A., Ostropolets, A., Minty, E., Desai, P., Bu, F., Toy, B., Hribar, M., Falconer, T., Zhang, L., Lawrence-Archer, L., Boland, M. V., Goetz, K., Hall, N., Shoaibi, A., Reps, J., Sena, A. G., Blacketer, C., Swerdel, J., Jhaveri, K. D., Lee, E., Gilbert, Z., Zeger, S. L., Crews, D. C., Suchard, M. A., Hripcsak, G., & Ryan, P. B.
Affiliations
  • Johns Hopkins University (US)
  • Hofstra University (US)
  • Columbia University (US)
  • United States Department of Veterans Affairs (US)
  • Vanderbilt University (US)
  • Northeastern University (US)
  • Cambridge Intellectual Property (United Kingdom) (GB)
  • University of Calgary (CA)
  • Stanford Health Care (US)
  • University of California, Los Angeles (US)
  • University of Southern California (US)
  • National Institutes of Health (US)
  • Massachusetts Eye and Ear Infirmary (US)
  • Erasmus MC (NL)
  • Northwell Health (US)
Corresponding author
Cai, Cindy X.
ORCID
Venue
Ophthalmology Retina
Publisher
Elsevier BV
Published
2024-08
Volume
8
Issue
8
Pages
733-743
ISSN
2468-6530 (ISSN-L)
DOI
10.1016/j.oret.2024.03.014
PMC
PMC11298306
OpenAlex
W4394624476
Cited by
20
References
2
Citations by year
2026: 5 · 2025: 12 · 2024: 3
FWCI
7.95
Type
journal article
Language
en
Open access
Licence
Locations
  • Ophthalmology Retina (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, cc-by-nc-nd)
  • PubMed Central (acceptedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
Funders
NEI
Topics
  • Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
  • Health Sciences › Medicine › Ophthalmology › Drug-Induced Ocular Toxicity
  • Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
Keywords
renal failure, anti-VEGF therapy, ranibizumab, aflibercept, bevacizumab, intravitreal injection, diabetic retinopathy, diabetic macular edema, age-related macular degeneration, retinal vein occlusion, adverse drug reactions, drug safety, propensity score matching
MeSH terms
Bevacizumab, Ranibizumab, Aged, Blindness, Diabetic Retinopathy, Female, Follow-Up Studies, Humans, Macular Edema, Male, Middle Aged, Recombinant Fusion Proteins, Retinal Vein Occlusion, Retrospective Studies, Risk Factors, Incidence, Angiogenesis Inhibitors, Receptors, Vascular Endothelial Growth Factor, Vascular Endothelial Growth Factor A, Renal Insufficiency, Intravitreal Injections

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