Effect of intravitreal bevacizumab on kidney function and proteinuria among diabetic patients: a prospective observational study in Asian population.

Intravitreal bevacizumab showed no significant change in eGFR or UACR at one month but significant changes at six months.

• 50 patients with diabetes and proliferative diabetic retinopathy (PDR) and/or significant diabetic macular edema were included
• Study conducted at a tertiary care center in India
• No significant change in eGFR and UACR at one month (p > 0.05)
• Significant changes in eGFR and UACR were observed at six months (p < 0.05)

The diabetic kidney disease (DKD) subgroup showed significant worsening of eGFR compared to the non-DKD subgroup.

• Patients were stratified into DKD and non-DKD subgroups
• The DKD subgroup had higher proteinuria at baseline compared to the non-DKD subgroup
• The DKD subgroup had lower eGFR at baseline compared to the non-DKD subgroup
• Significant worsening of eGFR was reported in the DKD subgroup following bevacizumab injection

Baseline urinary albumin-to-creatinine ratio (UACR) was a significant predictor of worsening eGFR and UACR at six months.

• UACR and eGFR were measured at baseline, one month, and six months after intravitreal bevacizumab injection
• Higher baseline UACR was identified as an indicator of poor kidney outcomes
• Baseline UACR predicted both worsening of eGFR and worsening of UACR at six months

There is a scarcity of literature evaluating the effects of bevacizumab on kidney function and proteinuria, particularly in the Asian population.

• The authors note there is no prior literature on the effect of intravitreal bevacizumab on kidney function in the Asian population
• Many studies have investigated the ocular benefits of intravitreal bevacizumab but systemic renal effects have been understudied
• This prospective observational study was designed to address this gap

The study could not confirm that observed kidney function changes were independently caused by intravitreal bevacizumab, as no control group without bevacizumab exposure was included.

• The study was a prospective observational study without an active control group
• Authors compared findings with historical controls
• Authors state 'further studies with a control group without bevacizumab exposure are required to confirm the independent effect of intravitreal bevacizumab on kidney function and proteinuria'
• Natural progression of diabetic kidney disease could not be excluded as contributing to the observed worsening