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

Many studies have investigated the ocular benefits of intravitreal bevacizumab but there is scarcity of literature evaluating the effects of bevacizumab on kidney function and proteinuria especially in the Asian population. This study aims to investigate the effect of intravitreal injection of bevacizumab on proteinuria and kidney function in patients with diabetic retinopathy. This prospective observational study included 50 patients with diabetes and proliferative diabetic retinopathy (PDR) and/or significant diabetic macular edema, who have received intravitreal bevacizumab injection at a tertiary care center in India. Changes in the urinary albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR) at one month and six months after injection were measured. This study reported no significant change in eGFR and UACR at one month (p > 0.05), but significant changes were seen at six months (p < 0.05). The subgroup with diabetic kidney disease (DKD) reported significant worsening of eGFR compared to the non-DKD subgroup. However, the DKD subgroup also had higher proteinuria and lower eGFR at baseline. Baseline UACR was a significant predictor of worsening eGFR and UACR at six months. Patients with diabetic retinopathy who received intravitreal bevacizumab injections showed significant worsening of kidney function and proteinuria at six months but not at one month. Higher baseline UACR was indicator of poor kidney outcomes. However, further studies with a control group without bevacizumab exposure are required to confirm the independent effect of intravitreal bevacizumab on kidney function and proteinuria.