OBJECTIVES: To evaluate the risk of acute kidney injury (AKI) associated with intravitreal anti-vascular endothelial growth factor (anti-VEGF) drugs in patients with retinal diseases.

METHODS: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials for relevant studies on August 10, 2022, scanned the references of the identified studies and consulted pharmaceutical companies for unpublished trials. Randomized controlled trials (RCTs) comparing AKI between anti-VEGF drug (e.g., aflibercept, bevacizumab, brolucizumab and ranibizumab) users and controls, in conjunction with retinal diseases [e.g., age-related macular degeneration (AMD), polypoidal choroidal vasculopathy (PCV), diabetic retinopathy (DR) / diabetic macular edema (DME), retinal vein occlusion (RVO) and myopic choroidal neovascularization (mCNV)]. We used the Cochrane Risk of Bias Tool 1.0 to assess the study quality of included studies. Data were independently extracted by three reviewers and synthesized by fixed-effects model for pooling odds ratios (OR) using the Peto method.

RESULTS: We included 13 RCTs (4 and 9 trials for aflibercept and ranibizumab, respectively) with a total of 4,282 participants. No AKI events were reported by RCTs involving participants with PCV and mCNV or receiving bevacizumab or brolucizumab. The meta-analysis indicated intravitreal anti-VEGF drugs did not increase AKI risk, compared with controls (OR: 1.00, 95% CI: 0.49-2.04), and no differences in AKI risk were observed between different anti-VEGF drugs (OR: 1.10, 95% CI: 0.27-4.43 for aflibercept; OR: 0.97, 95% CI: 0.42-2.22 for ranibizumab) and between different retinal diseases (OR: 4.61, 95% CI: 0.07-284.13 for AMD; OR: 0.90, 95% CI: 0.42-1.93 for DR/DME; OR: 1.57, 95% CI: 0.16-15.88 for RVO).

CONCLUSIONS: Our findings from the meta-analysis of 13 RCTs suggested that intravitreal anti-VEGF drugs were not associated with AKI risk, regardless of which anti-VEGF drugs (aflibercept or ranibizumab) or retinal diseases (AMD, DR/DME or RVO) were involved.