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<p>Intravitreal therapy using anti-vascular endothelial growth factor (anti-VEGF) has transformed the approach to treating diabetic retinopathy (DR), but its application in individuals with diabetes and chronic kidney disease, the majority of whom have diabetic kidney disease, involves a complex evaluation of risks and benefits. Emerging evidence indicates that the systemic absorption of anti-VEGF agents administered intravitreally may lower circulating VEGF levels and negatively impact the renal endothelium, especially in individuals with pre-existing kidney issues. In this article, we showcase an evidence-based framework for the safe administration of anti-VEGF therapy in patients with DR accompanied by chronic kidney disease. We introduce a novel renoretinal syndrome, which we refer to as anti-VEGF-associated nephropathy (AVAN), and outline diagnostic criteria, severity classifications, biopsy indications, and treatment recommendations to guide clinical practice.</p>

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Evidence-Based Guidelines for Intravitreal Anti-VEGF Therapy for Diabetic Retinopathy in Chronic Kidney Disease

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年9月11日

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  • Sourabh Sharma,
  • Pradeep Venkatesh,
  • Sanjay Kalra,
  • Himanshu Verma,
  • Nitin Kapoor,
  • Lakshmi Nagendra,
  • A. G. Unnikrishnan,
  • Sudeep Prakash,
  • Manisha Sahay,
  • Maya Hada,
  • Devesh Kumawat,
  • Sree Bhushan Raju,
  • Radhika Tandon

摘要

Intravitreal therapy using anti-vascular endothelial growth factor (anti-VEGF) has transformed the approach to treating diabetic retinopathy (DR), but its application in individuals with diabetes and chronic kidney disease, the majority of whom have diabetic kidney disease, involves a complex evaluation of risks and benefits. Emerging evidence indicates that the systemic absorption of anti-VEGF agents administered intravitreally may lower circulating VEGF levels and negatively impact the renal endothelium, especially in individuals with pre-existing kidney issues. In this article, we showcase an evidence-based framework for the safe administration of anti-VEGF therapy in patients with DR accompanied by chronic kidney disease. We introduce a novel renoretinal syndrome, which we refer to as anti-VEGF-associated nephropathy (AVAN), and outline diagnostic criteria, severity classifications, biopsy indications, and treatment recommendations to guide clinical practice.