Acute Kidney Injury from Intravitreal Anti-vascular Endothelial Growth Factor Drugs: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Yu Chien Tsao; Ting Ying Chen; Li An Wang; Chia Chun Lee; Wan Ju Annabelle Lee; Sheng Min Hsu; Chi Chun Lai; Shih Chieh Shao; Jia Horung Hung; Edward Chia Cheng Lai

doi:10.1007/s40259-023-00621-6

Acute Kidney Injury from Intravitreal Anti-vascular Endothelial Growth Factor Drugs: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Yu Chien Tsao, Ting Ying Chen, Li An Wang, Chia Chun Lee, Wan Ju Annabelle Lee, Sheng Min Hsu, Chi Chun Lai, Shih Chieh Shao^*, Jia Horung Hung^*, Edward Chia Cheng Lai

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

9 Scopus citations

Abstract

Background: Several observational studies have reported acute kidney injury from intravitreal anti-vascular endothelial growth factor (anti-VEGF) drugs for retinal diseases. However, systematic reviews and meta-analyses of randomized controlled trials on this critical topic are scant. Objective: To evaluate acute kidney injury risk associated with intravitreal anti-VEGF drugs in patients with retinal diseases. Methods: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials on 12 July, 2023, and included randomized controlled trials reporting acute kidney injury between anti-VEGF drugs (e.g., aflibercept, bevacizumab, brolucizumab, and ranibizumab) and controls for retinal diseases (e.g., age-related macular degeneration, polypoidal choroidal vasculopathy, diabetic retinopathy/diabetic macular edema, retinal vein occlusion, and myopic choroidal neovascularization). Data were synthesized by a fixed-effects model for pooling odds ratios (ORs) using the Peto method. Results: We included 13 randomized controlled trials (four and nine trials for aflibercept and ranibizumab, respectively) with a total of 4282 participants. The meta-analysis indicated intravitreal anti-VEGF drugs did not increase the acute kidney injury risk, compared with controls (odds ratio [OR]: 1.00, 95% confidence interval [CI] 0.49–2.04, I ²: 0%), and no differences in the acute kidney injury risk were observed between different anti-VEGF drugs (OR: 1.10, 95% CI 0.27–4.43, I ²: 0% for aflibercept; OR: 0.97, 95% CI 0.42–2.22, I ²: 0% for ranibizumab) and between different retinal diseases (OR: 4.61, 95% CI 0.07–284.13, I ²: not applicable for age-related macular degeneration; OR: 0.90, 95% CI 0.42–1.93, I ²: 0% for diabetic retinopathy/diabetic macular edema; OR: 1.57, 95% CI 0.16–15.88, I ²: 0% for retinal vein occlusion). Conclusions: Intravitreal anti-VEGF drugs were not associated with an acute kidney injury risk, regardless of which anti-VEGF drugs (aflibercept or ranibizumab) or retinal diseases (age-related macular degeneration, diabetic retinopathy/diabetic macular edema, or retinal vein occlusion) were involved. Systematic Review Protocol Registration: PROSPERO CRD42021267854.

Original language	English
Pages (from-to)	843-854
Number of pages	12
Journal	BioDrugs
Volume	37
Issue number	6
DOIs	https://doi.org/10.1007/s40259-023-00621-6
State	Published - 11 2023
Externally published	Yes

Bibliographical note

Keywords

Humans
Acute Kidney Injury/chemically induced
Angiogenesis Inhibitors/adverse effects
Bevacizumab/adverse effects
Diabetic Retinopathy/drug therapy
Endothelial Growth Factors/therapeutic use
Intravitreal Injections
Macular Degeneration/chemically induced
Macular Edema/drug therapy
Randomized Controlled Trials as Topic
Ranibizumab/adverse effects
Recombinant Fusion Proteins/adverse effects
Retinal Diseases/chemically induced
Retinal Vein Occlusion/drug therapy
Systematic Reviews as Topic
Vascular Endothelial Growth Factor A
Vascular Endothelial Growth Factors/antagonists & inhibitors

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1007/s40259-023-00621-6

Cite this

@article{d92e294feeff4f3eaa8850370c07986a,

title = "Acute Kidney Injury from Intravitreal Anti-vascular Endothelial Growth Factor Drugs: A Systematic Review and Meta-analysis of Randomized Controlled Trials",

abstract = "Background: Several observational studies have reported acute kidney injury from intravitreal anti-vascular endothelial growth factor (anti-VEGF) drugs for retinal diseases. However, systematic reviews and meta-analyses of randomized controlled trials on this critical topic are scant. Objective: To evaluate acute kidney injury risk associated with intravitreal anti-VEGF drugs in patients with retinal diseases. Methods: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials on 12 July, 2023, and included randomized controlled trials reporting acute kidney injury between anti-VEGF drugs (e.g., aflibercept, bevacizumab, brolucizumab, and ranibizumab) and controls for retinal diseases (e.g., age-related macular degeneration, polypoidal choroidal vasculopathy, diabetic retinopathy/diabetic macular edema, retinal vein occlusion, and myopic choroidal neovascularization). Data were synthesized by a fixed-effects model for pooling odds ratios (ORs) using the Peto method. Results: We included 13 randomized controlled trials (four and nine trials for aflibercept and ranibizumab, respectively) with a total of 4282 participants. The meta-analysis indicated intravitreal anti-VEGF drugs did not increase the acute kidney injury risk, compared with controls (odds ratio [OR]: 1.00, 95\% confidence interval [CI] 0.49–2.04, I 2: 0\%), and no differences in the acute kidney injury risk were observed between different anti-VEGF drugs (OR: 1.10, 95\% CI 0.27–4.43, I 2: 0\% for aflibercept; OR: 0.97, 95\% CI 0.42–2.22, I 2: 0\% for ranibizumab) and between different retinal diseases (OR: 4.61, 95\% CI 0.07–284.13, I 2: not applicable for age-related macular degeneration; OR: 0.90, 95\% CI 0.42–1.93, I 2: 0\% for diabetic retinopathy/diabetic macular edema; OR: 1.57, 95\% CI 0.16–15.88, I 2: 0\% for retinal vein occlusion). Conclusions: Intravitreal anti-VEGF drugs were not associated with an acute kidney injury risk, regardless of which anti-VEGF drugs (aflibercept or ranibizumab) or retinal diseases (age-related macular degeneration, diabetic retinopathy/diabetic macular edema, or retinal vein occlusion) were involved. Systematic Review Protocol Registration: PROSPERO CRD42021267854.",

keywords = "Humans, Acute Kidney Injury/chemically induced, Angiogenesis Inhibitors/adverse effects, Bevacizumab/adverse effects, Diabetic Retinopathy/drug therapy, Endothelial Growth Factors/therapeutic use, Intravitreal Injections, Macular Degeneration/chemically induced, Macular Edema/drug therapy, Randomized Controlled Trials as Topic, Ranibizumab/adverse effects, Recombinant Fusion Proteins/adverse effects, Retinal Diseases/chemically induced, Retinal Vein Occlusion/drug therapy, Systematic Reviews as Topic, Vascular Endothelial Growth Factor A, Vascular Endothelial Growth Factors/antagonists \& inhibitors",

author = "Tsao, \{Yu Chien\} and Chen, \{Ting Ying\} and Wang, \{Li An\} and Lee, \{Chia Chun\} and Lee, \{Wan Ju Annabelle\} and Hsu, \{Sheng Min\} and Lai, \{Chi Chun\} and Shao, \{Shih Chieh\} and Hung, \{Jia Horung\} and Lai, \{Edward Chia Cheng\}",

note = "{\textcopyright} 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.",

year = "2023",

month = nov,

doi = "10.1007/s40259-023-00621-6",

language = "英语",

volume = "37",

pages = "843--854",

journal = "BioDrugs",

issn = "1173-8804",

publisher = "Adis",

number = "6",

}

TY - JOUR

T1 - Acute Kidney Injury from Intravitreal Anti-vascular Endothelial Growth Factor Drugs

T2 - A Systematic Review and Meta-analysis of Randomized Controlled Trials

AU - Tsao, Yu Chien

AU - Chen, Ting Ying

AU - Wang, Li An

AU - Lee, Chia Chun

AU - Lee, Wan Ju Annabelle

AU - Hsu, Sheng Min

AU - Lai, Chi Chun

AU - Shao, Shih Chieh

AU - Hung, Jia Horung

AU - Lai, Edward Chia Cheng

PY - 2023/11

Y1 - 2023/11

N2 - Background: Several observational studies have reported acute kidney injury from intravitreal anti-vascular endothelial growth factor (anti-VEGF) drugs for retinal diseases. However, systematic reviews and meta-analyses of randomized controlled trials on this critical topic are scant. Objective: To evaluate acute kidney injury risk associated with intravitreal anti-VEGF drugs in patients with retinal diseases. Methods: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials on 12 July, 2023, and included randomized controlled trials reporting acute kidney injury between anti-VEGF drugs (e.g., aflibercept, bevacizumab, brolucizumab, and ranibizumab) and controls for retinal diseases (e.g., age-related macular degeneration, polypoidal choroidal vasculopathy, diabetic retinopathy/diabetic macular edema, retinal vein occlusion, and myopic choroidal neovascularization). Data were synthesized by a fixed-effects model for pooling odds ratios (ORs) using the Peto method. Results: We included 13 randomized controlled trials (four and nine trials for aflibercept and ranibizumab, respectively) with a total of 4282 participants. The meta-analysis indicated intravitreal anti-VEGF drugs did not increase the acute kidney injury risk, compared with controls (odds ratio [OR]: 1.00, 95% confidence interval [CI] 0.49–2.04, I 2: 0%), and no differences in the acute kidney injury risk were observed between different anti-VEGF drugs (OR: 1.10, 95% CI 0.27–4.43, I 2: 0% for aflibercept; OR: 0.97, 95% CI 0.42–2.22, I 2: 0% for ranibizumab) and between different retinal diseases (OR: 4.61, 95% CI 0.07–284.13, I 2: not applicable for age-related macular degeneration; OR: 0.90, 95% CI 0.42–1.93, I 2: 0% for diabetic retinopathy/diabetic macular edema; OR: 1.57, 95% CI 0.16–15.88, I 2: 0% for retinal vein occlusion). Conclusions: Intravitreal anti-VEGF drugs were not associated with an acute kidney injury risk, regardless of which anti-VEGF drugs (aflibercept or ranibizumab) or retinal diseases (age-related macular degeneration, diabetic retinopathy/diabetic macular edema, or retinal vein occlusion) were involved. Systematic Review Protocol Registration: PROSPERO CRD42021267854.

AB - Background: Several observational studies have reported acute kidney injury from intravitreal anti-vascular endothelial growth factor (anti-VEGF) drugs for retinal diseases. However, systematic reviews and meta-analyses of randomized controlled trials on this critical topic are scant. Objective: To evaluate acute kidney injury risk associated with intravitreal anti-VEGF drugs in patients with retinal diseases. Methods: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials on 12 July, 2023, and included randomized controlled trials reporting acute kidney injury between anti-VEGF drugs (e.g., aflibercept, bevacizumab, brolucizumab, and ranibizumab) and controls for retinal diseases (e.g., age-related macular degeneration, polypoidal choroidal vasculopathy, diabetic retinopathy/diabetic macular edema, retinal vein occlusion, and myopic choroidal neovascularization). Data were synthesized by a fixed-effects model for pooling odds ratios (ORs) using the Peto method. Results: We included 13 randomized controlled trials (four and nine trials for aflibercept and ranibizumab, respectively) with a total of 4282 participants. The meta-analysis indicated intravitreal anti-VEGF drugs did not increase the acute kidney injury risk, compared with controls (odds ratio [OR]: 1.00, 95% confidence interval [CI] 0.49–2.04, I 2: 0%), and no differences in the acute kidney injury risk were observed between different anti-VEGF drugs (OR: 1.10, 95% CI 0.27–4.43, I 2: 0% for aflibercept; OR: 0.97, 95% CI 0.42–2.22, I 2: 0% for ranibizumab) and between different retinal diseases (OR: 4.61, 95% CI 0.07–284.13, I 2: not applicable for age-related macular degeneration; OR: 0.90, 95% CI 0.42–1.93, I 2: 0% for diabetic retinopathy/diabetic macular edema; OR: 1.57, 95% CI 0.16–15.88, I 2: 0% for retinal vein occlusion). Conclusions: Intravitreal anti-VEGF drugs were not associated with an acute kidney injury risk, regardless of which anti-VEGF drugs (aflibercept or ranibizumab) or retinal diseases (age-related macular degeneration, diabetic retinopathy/diabetic macular edema, or retinal vein occlusion) were involved. Systematic Review Protocol Registration: PROSPERO CRD42021267854.

KW - Humans

KW - Acute Kidney Injury/chemically induced

KW - Angiogenesis Inhibitors/adverse effects

KW - Bevacizumab/adverse effects

KW - Diabetic Retinopathy/drug therapy

KW - Endothelial Growth Factors/therapeutic use

KW - Intravitreal Injections

KW - Macular Degeneration/chemically induced

KW - Macular Edema/drug therapy

KW - Randomized Controlled Trials as Topic

KW - Ranibizumab/adverse effects

KW - Recombinant Fusion Proteins/adverse effects

KW - Retinal Diseases/chemically induced

KW - Retinal Vein Occlusion/drug therapy

KW - Systematic Reviews as Topic

KW - Vascular Endothelial Growth Factor A

KW - Vascular Endothelial Growth Factors/antagonists & inhibitors

UR - https://www.scopus.com/pages/publications/85169882344

U2 - 10.1007/s40259-023-00621-6

DO - 10.1007/s40259-023-00621-6

M3 - 文献综述

C2 - 37676536

AN - SCOPUS:85169882344

SN - 1173-8804

VL - 37

SP - 843

EP - 854

JO - BioDrugs

JF - BioDrugs

IS - 6

ER -

Acute Kidney Injury from Intravitreal Anti-vascular Endothelial Growth Factor Drugs: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract

Bibliographical note

Keywords

UN SDGs

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