Associations between intravitreal anti–vascular endothelial growth factor therapy and adverse renal outcomes

PURPOSE: Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is widely used for retinal vascular diseases, but its renal safety remains controversial. This study evaluated the risk of adverse renal outcomes following intravitreal anti-VEGF therapy. METHODS: This retrospective cohort study used the TriNetX Global Network. Adults aged over 20 years with retinal vascular disorders who received intravitreal anti-VEGF injections were compared with those who did not. Propensity score matching (1:1) balanced baseline demographics, comorbidities, medication use, laboratory data, and healthcare utilization. The primary outcome was major adverse kidney events (MAKE), defined as end-stage renal disease, dialysis, or all-cause mortality. Risks of progression to chronic kidney disease (CKD) stage 3-5 and dialysis were also analyzed. Cox proportional hazards models estimated hazard ratios (HRs). RESULTS: Among 7194 matched pairs (anti-VEGF cohort: mean age, 55.2±12.9 years, 55.2% male; control cohort: mean age, 55.7±11.6 years, 53.9% male), the anti-VEGF cohort showed a significantly higher risk of MAKE at 1 year (230 [3.20%] vs 146 [2.03%]; HR, 1.53 [1.25-1.89]), with similar findings at 3 and 5 years. The anti-VEGF cohort also showed higher risks of CKD stage 3-5 (769 [10.69%] vs 556 [7.73%]; HR, 1.37 [1.23-1.53]) and dialysis (70 [0.97%] vs 38 [0.53%]; HR, 1.79 [1.20-2.65]). CONCLUSION: In this real-world cohort, intravitreal anti-VEGF therapy was associated with higher risks of adverse renal outcomes. Given the observational design and small absolute risk differences, these findings warrant cautious interpretation, and renal function monitoring may be considered in these patients.