Effect of a Single Intravitreal Bevacizumab Injection on Proteinuria in Patients With Diabetes

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Abstract

Purpose

Proteinuria is the second most common complication after hypertension after systemic administration of bevacizumab. Therefore we aimed to analyze the effect of intravitreal bevacizumab (IVB) injection on proteinuria in patients with diabetes.

Methods

Patients scheduled to receive IVB injection from May 1, 2018, to December 31, 2018, were prospectively enrolled. In total, 53 patients with diabetes (26 with nonproliferative diabetic retinopathy and 27 with proliferative diabetic retinopathy) and 37 patients without diabetes were included. Urine tests were performed within 1 month of and 7 ± 1 days after IVB injection. Urinary protein, creatinine, and albumin concentrations were quantitatively measured, and urinary protein-to-creatinine ratio and urinary albumin-to-creatinine ratio (UACR) were calculated from these data before and after IVB injection.

Results

The mean urinary microalbumin concentrations and urinary protein-to-creatinine ratio were significantly higher in patients with diabetes, both before and after IVB injection. There were no differences between patients with nonproliferative diabetic retinopathy and proliferative diabetic retinopathy. About 80% of patients with diabetes showed improved albuminuria or at least no harmful effect in terms of albuminuria. Patients with deteriorated baseline UACR showed more residual increase in UACR after IVB injection ( P < 0.05 in all groups).

Conclusions

Close monitoring of renal function after IVB might be needed in patients with diabetes according to the severity of nephropathy.

Translational Relevance

Our results may provide information regarding the renal function of IVB-treated patients with diabetes.

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Most cited references 33

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Is Open Access

Data Resource Profile: The National Health Information Database of the National Health Insurance Service in South Korea

Sang Cheol Seong, Yeon-Yong Kim, Young-Ho Khang … (2016)

Data resource basics The National Health Information Database (NHID) is a public database on health care utilization, health screening, socio-demographic variables, and mortality for the whole population of South Korea, formed by the National Health Insurance Service. The population included in the data is over 50 million, and the participation rate in the health screening programs was 74.8% in 2014. The NHID covers data between 2002 and 2014. Those insured by NHI pay insurance contributions and receive medical services from their health care providers. The NHIS, as the single insurer, pays costs based on the billing records of health care providers (Figure 1). To govern and carry out these processes in the NHI, the NHIS built a data warehouse to collect the required information on insurance eligibility, insurance contributions, medical history, and medical institutions. In 2012, the NHIS formed the NHID using information from medical treatment and health screening records and eligibility data from an existing database system. Figure 1. The governance of the National Health Insurance of South Korea. Data collected The eligibility database includes information about income-based insurance contributions, demographic variables, and date of death. The national health screening database includes information on health behaviors and bio-clinical variables. The health care utilization database includes information on records on inpatient and outpatient usage (diagnosis, length of stay, treatment costs, services received) and prescription records (drug code, days prescribed, daily dosage). The long-term care insurance database includes information about activities of daily living and service grades. The health care provider database includes data about the types of institutions, human resources, and equipment. In the NHID, de-identified join keys replacing the personal identifiers are used to interlink these databases. Data resource use Papers published covered various diseases or health conditions like infectious diseases, cancer, cardiovascular diseases, hypertension, diabetes mellitus, and injuries and risk factors such as smoking, alcohol consumption, and obesity. The impacts of health care and public health policies on health care utilization have been also explored since the data include all the necessary information reflecting patterns of health care utilization. Reasons to be cautious First, information on diagnosis and disease may not be optimal for identifying disease occurrence and prevalence since the data have been collected for medical service claims and reimbursement. However, the NHID also collects prescription data with secondary diagnosis, so the accuracy of the disease information can be improved. Second, the data linkage with other secondary national data is not widely available due to privacy issues in Korea. Governmental discussions on the statutory reform of data linkage using the NHID are under way. Collaboration and data access Access to the NHID can be obtained through the Health Insurance Data Service home page (http://nhiss.nhis.or.kr). An ethics approval from the researchers’ institutional review board is required with submission of a study proposal, which is reviewed by the NHIS review committee before providing data. Further inquiries on data use can be obtained by contacting the corresponding author. Funding and competing interests This work was supported by the NHIS in South Korea. The authors declare no competing interests.

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Glomerular-specific alterations of VEGF-A expression lead to distinct congenital and acquired renal diseases.

Vera Eremina, Manish Sood, Jody Haigh … (2003)

Kidney disease affects over 20 million people in the United States alone. Although the causes of renal failure are diverse, the glomerular filtration barrier is often the target of injury. Dysregulation of VEGF expression within the glomerulus has been demonstrated in a wide range of primary and acquired renal diseases, although the significance of these changes is unknown. In the glomerulus, VEGF-A is highly expressed in podocytes that make up a major portion of the barrier between the blood and urinary spaces. In this paper, we show that glomerular-selective deletion or overexpression of VEGF-A leads to glomerular disease in mice. Podocyte-specific heterozygosity for VEGF-A resulted in renal disease by 2.5 weeks of age, characterized by proteinuria and endotheliosis, the renal lesion seen in preeclampsia. Homozygous deletion of VEGF-A in glomeruli resulted in perinatal lethality. Mutant kidneys failed to develop a filtration barrier due to defects in endothelial cell migration, differentiation, and survival. In contrast, podocyte-specific overexpression of the VEGF-164 isoform led to a striking collapsing glomerulopathy, the lesion seen in HIV-associated nephropathy. Our data demonstrate that tight regulation of VEGF-A signaling is critical for establishment and maintenance of the glomerular filtration barrier and strongly supports a pivotal role for VEGF-A in renal disease.

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Diabetic Microvascular Disease: An Endocrine Society Scientific Statement

Eugene Barrett, Zhenqi Liu, Mogher H Khamaisi … (2017)

Both type 1 and type 2 diabetes adversely affect the microvasculature in multiple organs. Our understanding of the genesis of this injury and of potential interventions to prevent, limit, or reverse injury/dysfunction is continuously evolving. This statement reviews biochemical/cellular pathways involved in facilitating and abrogating microvascular injury. The statement summarizes the types of injury/dysfunction that occur in the three classical diabetes microvascular target tissues, the eye, the kidney, and the peripheral nervous system; the statement also reviews information on the effects of diabetes and insulin resistance on the microvasculature of skin, brain, adipose tissue, and cardiac and skeletal muscle. Despite extensive and intensive research, it is disappointing that microvascular complications of diabetes continue to compromise the quantity and quality of life for patients with diabetes. Hopefully, by understanding and building on current research findings, we will discover new approaches for prevention and treatment that will be effective for future generations.

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Author and article information

Journal

Journal ID (nlm-ta): Transl Vis Sci Technol

Journal ID (iso-abbrev): Transl Vis Sci Technol

Journal ID (pmc): tvst

Journal ID (publisher-id): TVST

Title: Translational Vision Science & Technology

Publisher: The Association for Research in Vision and Ophthalmology

ISSN (Electronic): 2164-2591

Publication date (Electronic): 09 March 2020

Publication date Collection: March 2020

Volume: 9

Issue: 4

Electronic Location Identifier: 4

Affiliations

[1 ] Department of Ophthalmology, Ajou University School of Medicine , Suwon, Korea

[2 ] Institute of Medical Science, Ajou University School of Medicine , Suwon, Korea

[3 ] Fight against Angiogenesis-Related Blindness (FARB) Laboratory, Clinical Research Institute, Seoul National University Hospital , Seoul, Korea

[4 ] Department of Biomedical Sciences, Seoul National University College of Medicine , Seoul, Korea

[5 ] Department of Ophthalmology, Seoul National University College of Medicine , Seoul, Korea

Author notes

[* ] Correspondence: Kihwang Lee, MD, PhD, Department of Ophthalmology, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, 16499 Suwon, Korea. e-mail: kie114@ 123456hanmail.net

Article

Publisher ID: TVST-19-2023

DOI: 10.1167/tvst.9.4.4

PMC ID: 7396195

PubMed ID: 32818092

SO-VID: 2e03f43e-af1f-4dab-912d-090370652009

License:

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

History

Date accepted : 09 December 2019

Date received : 07 October 2019

Page count

Pages: 9

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Effect of a Single Intravitreal Bevacizumab Injection on Proteinuria in Patients With Diabetes

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Most cited references 33

Data Resource Profile: The National Health Information Database of the National Health Insurance Service in South Korea

Glomerular-specific alterations of VEGF-A expression lead to distinct congenital and acquired renal diseases.

Diabetic Microvascular Disease: An Endocrine Society Scientific Statement

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