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Multicenter Study
. 2025 Jun;48(3):100771.
doi: 10.1016/j.bj.2024.100771. Epub 2024 Jul 19.

Association between pentoxifylline use and diabetic retinopathy in patients with type 2 diabetes mellitus and chronic kidney disease: A multi-institutional cohort study

Tzu-Yi Lin  1 , Eugene Yu-Chuan Kang  2 , Nan-Kai Wang  3 , Je-Ho Kang  4 , Kuan-Jen Chen  5 , Wei-Chi Wu  5 , Chi-Chun Lai  5 , Yih-Shiou Hwang  6
Affiliations
Multicenter Study

Association between pentoxifylline use and diabetic retinopathy in patients with type 2 diabetes mellitus and chronic kidney disease: A multi-institutional cohort study

Tzu-Yi Lin et al. Biomed J. 2025 Jun.

Abstract

Background: Pentoxifylline is administered to improve the hemodynamics of patients with chronic kidney disease (CKD). Despite the improvement of capillary blood flow velocity in the retina after pentoxifylline use, no evidence has been provided to prove the protective effect against diabetic retinopathy (DR). Therefore, this study aimed to assess the risk of DR in pentoxifylline users with CKD and diabetes mellitus (DM).

Material and methods: In this retrospective cohort study, the Chang Gung Research Database, which includes the data of patients with CKD and DM from 2003 to 2019, was used. Each calendar year was divided into 4 data units with 3 months each for every patient and every year during the follow-up. The ocular outcomes were new-onset DR, DR-related complications, and vitreoretinal interventions.

Results: A total of 56,439 patients without preexisting DR and 5039 patients with preexisting DR were included in this study. Exposure to pentoxifylline was associated with an elevated risk of new-onset DR (adjusted hazard ratio = 1.24, 95% confidence interval = 1.13-1.36) in patients without preexisting DR. Additionally, exposure to pentoxifylline was associated with an elevated risk of DR-related complications and vitreoretinal interventions in patients with or without preexisting DR.

Conclusions: Exposure to pentoxifylline is associated with an elevated risk of DR, regardless of whether patients have preexisting DR.

Keywords: Diabetic retinopathy; Pentoxifylline; Progression; Risks.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. .

Figures

Fig. 1
Fig. 1
Selection process of the study population. Abbreviations: CKD, chronic kidney disease; DM, diabetes mellitus; DR, diabetic retinopathy; HbA1c, glycated hemoglobin; ICH, intracranial hemorrhage; MI, myocardial infarction.
Fig. 2
Fig. 2
Study design and follow-up period.
Fig. 3
Fig. 3
Forest plot for ocular and systemic outcomes of patients without pre-existing DR. Abbreviation: DR: diabetic retinopathy.
Fig. 4
Fig. 4
Subgroup analysis of ocular outcomes of patients without pre-existing DR. Abbreviation: DR: diabetic retinopathy.
Fig. 5
Fig. 5
Forest plot for ocular and systemic outcomes of patients with pre-existing DR. Abbreviation: DR: diabetic retinopathy.
Fig. 6
Fig. 6
Subgroup analysis of ocular outcomes of patients with pre-existing DR. Abbreviation: DR: diabetic retinopathy.
See this image and copyright information in PMC

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