Abstract: SA-PO156
Toxic Renal Effects from Intravitreal Bevacizumab for Proliferative Diabetic Retinopathy in the Patients with Chronic Diabetic Kidney Disease
Session Information
- Diabetic Kidney Disease: Clinical - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 602 Diabetic Kidney Disease: Clinical
Authors
- Kamarzarian, Anita, UCLA -Olive View Medical Center, La Canada, California, United States
- Au, Adrian, University of California, Los Angeles, Los Angeles, California, United States
- Yung, Madeline, UCLA, Los Angeles, California, United States
- Zaki, Kirollos Emad, Olive View - UCLA Medical Center, Sylmar, California, United States
- Pole, Cameron, UCLA, Los Angeles, California, United States
- Jafari, Golriz, UCLA-Olive View Medical Center, Los Angeles, California, United States
- Pham, Phuong-Chi T., UCLA-Olive View Medical Center, Los Angeles, California, United States
Background
Intravitreal injection of Bevacizumab, a monoclonal antibody directed against the vascular endothelial growth factor (VEGF), has revolutionized the management of proliferative diabetic retinopathy and diabetic macular edema.
Here we evaluate the effects of intravitreal bevacizumab on renal parameters.
Methods
This study is a consecutive case-control retrospective study performed from January 01, 2016 to January 01, 2017 at the Olive View-UCLA Medical Center. An initial screening of all 2763 encounters in the outpatient adult renal clinic during the study period was performed to identify patients with proliferative Diabetic retinopathy (PDR) recieving bevacizumab intravitreal injections and were age matched controls with dilated fundoscopic exams demonstrating sin diabetic retinopathy (sDR), non-proliferative diabetic retinopathy (NPDR), or PDR without bevacizumab. T0 is defined as the first injection of bevacizumab. The average follow-up prior to T0 was empirically determined to be 13.15 months.
Data collected from EMR and statistical tests were performed on Microsoft Excel.
Results
Patients treated with bevacizumab had significantly higher incidence of dialysis with 50% requiring dialysis as compared to 7.1% in NPDR and PDR groups.
After injection the eGFR decline over 12 months in the bevacizumab group was twice as rapid as PDR without bevacizumab (p=0.02) and four times as rapid as NPDR (p = 2.67E-0.5).
There was an increase in the amount of anti-hypertensive medications used to manage HTN from 1.9 ± 1.2 to 3.2 ± 1.3 (p=0.01)
Conclusion
Diabetic patients with diabetic CKD receiving intraocular anti-VEGF therapy have more rapid rate of progression of their CKD, have higher incidence of dialysis initiation and require more antihypertensive medications. We also noted both progression and higher level of proteinuria but could not capture this effect statistically based on our study scale.
Figure 1. Rate comparison for e-GFR change between groups