Intravitreal Bevacizumab and Kidney Outcomes in Diabetic Retinopathy: A 12-Month Comparative Study

Background: Bevacizumab, a VEGF inhibitor, is a newer treatment option for diabetic retinopathy (DR). While intravenous use is linked to kidney complications, the impact of intravitreal (IVT) Bevacizumab on renal function is unclear. This study compares eGFR decline in DR patients treated with IVT Bevacizumab versus those receiving laser therapy. Methods: This retrospective study reviewed records of DR patients treated with either IVT Bevacizumab or laser therapy from 2022 to 2024. It examined demographics, comorbidities, medications, renal function, blood pressure, and renal outcomes, comparing eGFR decline rates between the two groups over 12 months. Results: A total of 135 diabetic retinopathy patients (55.6% female; median age 64) were studied. The median eGFR was 60.49 mL/min/1.73m2, and baseline UACR was 290 mg/gCr. Among them, 101 (74.8%) received IVT Bevacizumab and 34 (25.2%) underwent laser therapy. Baseline eGFR was significantly lower in the Bevacizumab group (58.68 vs. 73.90, p = 0.021). At 12 months, the Bevacizumab group showed a greater eGFR decline than the laser group (-10.00 vs. -1.41 mL/min/1.73m2, p < 0.001; see Figure 1) and a higher rate of rapid eGFR decline (>5 mL/min/1.73m2/year) (69.3% vs. 29.4%, p < 0.001). UACR changes were not significant (p = 0.67). Factors linked to rapid eGFR decline from the multivariate analysis are shown in Table 1. Conclusion: IVT Bevacizumab administration in DR patients was associated with a greater decline in renal function compared to laser therapy over 12 months. Rapid eGFR decline correlated with elevated HbA1c, increased SBP, and cumulative Bevacizumab doses, whereas SGLT2i use was protective. These findings emphasize the necessity for careful renal monitoring during Bevacizumab treatment. - Factors OR (95% CI) p-value HbA1c % 1.39 (1.02-1.90) 0.036 Increase SBP >20 mmhg 7.14 (1.76-28.98) 0.006 SGLT2-inhibitors (SGLT2i) 0.05 (0.01-0.45) 0.008 Bevacizumab ≥ 5 dose 3.69 (1.26-10.81) 0.017