ArticleEye (London, England)2026
Comparison of adverse renal events between ranibizumab and aflibercept in patients with diabetic macular oedema: A global network study.
Article in Eye (London, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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7 authors.
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Abstract
purposePatients with diabetic macular oedema (DMO) are susceptible to renal injury, raising the risks of acute kidney injury (AKI) and end-stage renal disease (ESRD) associated with anti-VEGF therapies. We aimed to compare the risks of AKI and ESRD between aflibercept and ranibizumab in DMO patients, focusing on AKI and ESRD in conjunction with all-cause mortality.
methodsA target trial emulation using the TriNetX Global Collaborative Network included adult patients with DMO who initiated treatment with aflibercept or ranibizumab in routine clinical practice. Ranibizumab exposure reflected real-world use and included both approved dosages. Patients with pre-existing ESRD or chronic kidney disease stage 5 were excluded. Propensity score matching was applied to balance demographics, comorbidities, medication use, and laboratory parameters. Time-to-event analyses were performed for AKI, ESRD, and all-cause mortality. Sensitivity analyses included application of a minimum 7-day latency window after treatment initiation to address potential temporality bias.
resultsAfter matching, 3411 patients were included in each treatment group (mean age, 64.0 ± 12.4 years; 51.5% male). During follow-up, aflibercept was not associated with an increased risk of AKI (hazard ratio [HR]: 0.97, 95% confidence interval [CI]: 0.89-1.06), ESRD (HR: 0.95, 95% CI: 0.83-1.09), or all-cause mortality (HR: 0.99, 95% CI: 0.89-1.10), when compared with ranibizumab. Results were consistent across subgroup and sensitivity analyses, including analyses incorporating a 7-day latency window with an HR of 1.08 (95% CI: 0.94-1.24) for AKI, and 0.89 (95% CI: 0.76-1.04) for ESRD.
conclusionsIn this multinational, real-world study, aflibercept and ranibizumab demonstrated comparable risks of AKI, ESRD and mortality among patients with DMO after adjustment for measured confounders. Given the observational design, real-world dose heterogeneity, and limitations in detailed treatment-timing data, these findings should be interpreted with caution.
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