Retina Society 2026: Anti-VEGF's impact on kidney function

At Retina Society 2026, Manju Subramanian, MD, an associate professor at Boston University and vice-chairman of faculty affairs at Boston University Eye Associates, discussed a study examining the impact of anti-VEGF therapy on kidney function in patients with diabetic retinopathy and retinal vein occlusion (RVO). Subramanian said the project began when a nephrologist treating a shared patient asked her to switch the patient from bevacizumab to ranibizumab, questioning whether anti-VEGF injections were worsening the patient's kidney function. She said she found the existing literature on the topic equivocal, and the timing coincided with a new chief of nephrology at Boston Medical Center who was independently interested in studying anti-VEGF's effect on kidney disease markers, including albumin and estimated glomerular filtration rate (eGFR).

The study, and what it found

Subramanian said she used the TriNetX database, a global research platform with more than 180 million patient records, because it allows statistical analysis directly on the platform without requiring users to download raw data. She said she chose to examine both patients with diabetic retinopathy and patients with RVO, the latter to provide a largely non-diabetic comparison group.

Subramanian said her team propensity score matched patients who received a minimum of 3 anti-VEGF injections against a control group for variables including age, diabetic duration, A1c levels, hypertension, and clotting disorders that could predispose patients to RVO. She defined worsening kidney function as an eGFR decline from above 60 to below 45, corresponding to a shift from mild to more advanced stages of kidney disease. The analysis found reduced kidney function in both the diabetic retinopathy group and the RVO group after patients received at least 3 anti-VEGF injections, comparing measurements before and after treatment in each group.