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Research Paper|Volume 14, Issue 12|pp 5116—5130

Risk of dialysis in patients receiving intravitreal anti–vascular endothelial growth factor treatment: a population-based cohort study

Shun-Fa Yang1,2, Yu-Chen Su3, Chen-Chee Lim3, Jing-Yang Huang1, Sheng-Min Hsu3, Li-Wha Wu4,5, Yi-Sheng Chang3, Jia-Horung Hung3,6
  • 1Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
  • 2Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
  • 3Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  • 4Institute of Molecular Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  • 5Department of Laboratory Science and Technology, Kaohsiung Medical University, Kaohsiung, Taiwan
  • 6Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
* Equal contribution as co-first authors
Received: March 9, 2022Accepted: June 14, 2022Published: June 20, 2022
https://doi.org/10.18632/aging.204133

Copyright: © 2022 Yang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

We utilized the Longitudinal Health Insurance Database which was stemmed from the Taiwan's National Health Insurance Research Database to conduct a retrospective cohort study investigating the risk of becoming dialysis dependent after receiving intravitreal anti-vascular endothelial growth factor (VEGF) agents for retinal diseases. Patients newly receiving intravitreal ranibizumab or aflibercept from 2000 to 2017 for age-related macular degeneration, polypoidal choroidal vasculopathy, diabetic macular edema, retinal vein occlusions, or myopic choroid neovascularization were included as the study group, and patients with same retinal diseases but did not receive intravitreal anti-VEGFs served as controls extracted by age- and sex-matched (1:4) and further propensity score matching (PSM). Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the risk of dialysis. A cohort of 2447 anti-VEGF users and 2447 controls by PSM were evaluated. Higher dialysis risks were observed among patients newly receiving anti-VEGF agents compared to controls (adjusted HR: 1.849; 95% CI: 1.378–2.482) in the PSM cohort. For subgroup analysis, patients newly receiving anti-VEGF treatment for diabetic macular edema had significant risk (adjusted HR: 1.834; 95% CI: 1.448–2.324) of becoming dialysis-dependent, while patients in other subgroups demonstrated similar risks as the controls. In conclusion, intravitreal anti-VEGF agents might increase the risk of becoming dialysis-dependent, especially in patients who are treated for diabetic macular edema.