RESUMO
Introduction: Intravitreal administration of vascular endothelial growth factor inhibitors (anti-VEGF) is the treatment of choice in retinal pathology associated with type 2 diabetes mellitus (DM2). We aimed to analyze the effect of intravitreal anti-VEGF administration on renal function in patients with DM2. Methods: This is a single-center retrospective and observational study of patients with DM2 with and without chronic kidney disease (CKD). We analyzed the evolution of renal function after anti-VEGF onset, compared with a control group. Results: We included 45 patients (55.6% male) who received anti-VEGF therapy. Mean age was 74.4±11.5 (50-91) years. These were compared with 45 patients with similar characteristics. After 12 months, 76.3% had CKD with a mean reduction in estimated glomerular filtration rate (eGFR) of 19.4%. Nine patients (20%) had a >25% reduction in eGFR, and 3 patients (6.7%) had a >50% reduction in GFR. At 24 months, 80% of patients had CKD with a mean eGFR decrease of 28%. The mean eGFR slope of patients who had received anti-VEGF treatment was 10 ml/min/year compared to 1.5 ml/min/year in the control group (P < 0.05). After the first administration, 5 patients (17.2%) in the CKD group required renal replacement therapy during follow-up (mean time 22±12 months). Main risk factors for need of dialysis were age, presence of previous CKD, and baseline proteinuria. Conclusion: Intravitreal anti-VEGF administration is a risk factor for CKD and rapid progression to end-stage kidney disease in patients with previous CKD. Knowing these drugs' implications is crucial to avoid CKD progression and opportunely limit their use in certain patients.
RESUMO
BACKGROUND: Messenger RNA vaccination against COVID-19 has been shown to produce an immune response with sufficient efficacy to prevent natural infection in immunocompetent recipients. However, the response in kidney transplant recipients is low. We aimed to evaluate the specific humoral response to SARS-CoV-2 after vaccination in a population of kidney transplant recipients and assess the main factors associated with a lack of response. METHODS: We undertook a prospective study of 105 kidney transplant recipients and 11 recipients of a combined kidney-pancreas transplant. We analyzed immunoglobulin G and immunoglobulin M antibodies after the patients received their second and third doses of the messenger RNA 1273 (Moderna) or BNT162b1 (BionTECH-Pfizer) vaccinations between February and November 2021. RESULTS: Mean (SD) age of the 116 patients was 50 (16) years, and 65% were men. They had their transplants for 40 months (IQR, 15-123 months), with 14% undergoing retransplant and 11% sensitized. The maintenance immunosuppression regimen was steroids + tacrolimus + mycophenolate (MMF) in 68% of the patients and any combination with mammalian target of rapamycin inhibitor (mTORi) in 28%. A humoral response developed in 40% of the patients 6 weeks (IQR, 4-10 weeks) after receiving the second dose of the vaccine. Of the 67 patients with no response to the second dose, 51 had an analysis of the humoral response after the third dose, which was positive in 16 (31%). A total of 80% received the Moderna vaccine and 20% the BionTECH-Pfizer. No patient experienced major adverse effects after the vaccination. Factors associated with a lack of humoral response to the vaccine were recipient age (odds ratio [OR], 1.02; 95% CI, 1.001-1.05; P = .04), diabetes (OR, 2.8; 95% CI, 1.2-6.9; P = .02), and treatment with MMF (OR, 2.6; 95% CI, 1.08-6.8; P = .03). Treatment with mTORi was associated with a better response to vaccination (OR, 0.3; 95% CI, 0.1-0.9; P = .04). CONCLUSIONS: The humoral response to the COVID-19 vaccine in kidney transplant recipients is poor. Factors related with this lack of immunity are recipient age and diabetes, plus MMF therapy, whereas mTORi therapy was associated with a better response to vaccination.
Assuntos
Vacinas contra COVID-19 , COVID-19 , Transplante de Rim , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anticorpos Antivirais , Vacina BNT162 , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Terapia de Imunossupressão , Transplante de Rim/efeitos adversos , Estudos Prospectivos , RNA Mensageiro , SARS-CoV-2 , Transplantados , VacinaçãoRESUMO
No disponible
Assuntos
Humanos , Masculino , Idoso , Carcinoma de Células Renais/tratamento farmacológico , Neoplasias Renais/tratamento farmacológico , Nefrite Intersticial/induzido quimicamente , Nivolumabe/efeitos adversos , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Rim/patologia , Nefrite Intersticial/patologia , Nivolumabe/administração & dosagem , Sunitinibe/administração & dosagem , Sunitinibe/efeitos adversosAssuntos
Carcinoma de Células Renais/tratamento farmacológico , Inibidores de Checkpoint Imunológico/efeitos adversos , Neoplasias Renais/tratamento farmacológico , Nefrite Intersticial/induzido quimicamente , Nivolumabe/efeitos adversos , Idoso , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Humanos , Inibidores de Checkpoint Imunológico/administração & dosagem , Rim/patologia , Masculino , Nefrite Intersticial/patologia , Nivolumabe/administração & dosagem , Sunitinibe/administração & dosagem , Sunitinibe/efeitos adversosRESUMO
No disponible
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Humanos , Feminino , Idoso , Síndrome Hemolítico-Urêmica Atípica/induzido quimicamente , Síndrome Hemolítico-Urêmica Atípica/tratamento farmacológico , Inibidores de Proteassoma/efeitos adversos , Anticorpos Monoclonais Humanizados/uso terapêutico , Mieloma Múltiplo/tratamento farmacológicoRESUMO
No disponible
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Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pulmonares/patologia , Neoplasias Encefálicas/secundário , Síndrome Nefrótica/induzido quimicamente , Antineoplásicos Imunológicos/efeitos adversos , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagemAssuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Síndrome Hemolítico-Urêmica Atípica/tratamento farmacológico , Inativadores do Complemento/uso terapêutico , Oligopeptídeos/efeitos adversos , Idoso , Síndrome Hemolítico-Urêmica Atípica/induzido quimicamente , Feminino , Humanos , Mieloma Múltiplo/tratamento farmacológicoAssuntos
Adenocarcinoma/terapia , Antineoplásicos Imunológicos/efeitos adversos , Neoplasias Encefálicas/terapia , Ipilimumab/efeitos adversos , Neoplasias Pulmonares/patologia , Nivolumabe/efeitos adversos , Lobo Temporal , Adenocarcinoma/secundário , Antineoplásicos Imunológicos/uso terapêutico , Neoplasias Encefálicas/secundário , Feminino , Humanos , Ipilimumab/uso terapêutico , Nefropatias/induzido quimicamente , Neoplasias Pulmonares/terapia , Pessoa de Meia-Idade , Nivolumabe/uso terapêuticoRESUMO
No disponible