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Alice Bruynseels, Rita Pinto, Dawn Sim, Ranjan Rajendram; Diabetic Macular Oedema and Chronic Kidney Disease: Response to treatment with anti-vascular endothelial growth factor (VEGF). Invest. Ophthalmol. Vis. Sci. 2016;57(12):2115.
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© ARVO (1962-2015); The Authors (2016-present)
To establish treatment response of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy for Diabetic Macular Oedema (DME) in patients with Chronic Kidney Disease (CKD).
Data were collected retrospectively on patients with Type 1 and 2 Diabetes and CKD who had DME treated with ranibizumab between 2013 and 2015. Parameters analyzed included Optical Coherence Tomography (OCT) central retinal thickness (CRT), macular volume (MV), and visual acuity (VA), in injected and fellow, non-injected (control) eyes of patients at 4 months and 1 year. Renal parameters included: CKD stage, estimated glomerular filtration rate (eGFR) at baseline, 4 months and 1 year. Patients with less than 8 months follow-up, receiving less than 3 intravitreal injections or other anti-VEGF were excluded.
19 eyes of 16 patients were included, ethnicites were six White British, five Black and five South Asian (Indian/Pakistani). There were seven patients with stage 3 CKD, six stages 4 and 5, and three patients on haemodialysis (HD). The mean number of injections was 6 over 11.5 months. The mean change in VA was +10 ETDRS letters, mean reduction in CRT was -107µm and MV -1.49mm3. A trend was observed in non-injected (control) eyes, with thicker maculae in advanced CKD stages. In non-injected CKD stages 3a and 3b, the CRT was 239µm compared to 346µm in patients on haemodialysis (p=0.08). No differences were observed in injected eyes. At 1 year, reduction in CSFT (r=0.48, p=0.045) and MV (r=0.49, p=0.04) in the injected eye was correlated to the eGFR at 1 year. This relationship was not observed in the fellow non-injected (control) eyes.
Our data suggests severity of CKD was associated with severity of DME. We further observed that anti-VEGF injection therapy was beneficial in reducing macular thickness and volumes in patients with advancing renal disease (during the course of therapy) as defined by EGFR levels.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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