Vascular endothelial growth factor (VEGF) plays a significant role as a pro-angiogenic and pro-permeability factor within the kidney. Bevacizumab is a pharmaceutical monoclonal anti-VEGF antibody that inhibits the growth of new blood vessels, which blocks blood supply and thereby restricts tumor growth. Thus, we conducted a nationwide study to explore the risk of chronic kidney disease (CKD) development in Taiwan residents after bevacizumab therapy. We drew data from the extensive National Health Insurance Research Database (NHIRD), which encompasses data from >99% of Taiwan’s population from 1995 onwards. Individuals who received bevacizumab between 2012–2018 were identified as the bevacizumab cohort, with the index date set at the first usage. We randomly selected dates within the study period for the control group to serve as index dates. We excluded patients with a history of CKD prior to the index date or those <20 years old. In both cohorts, patients’ propensity scores matched in a 1:1 ratio based on sex, age, index year, income, urbanization level, comorbidities, and medications. We found patients treated with bevacizumab had a significantly higher risk of contracting CKD than patients without bevacizumab (adjusted hazard ratio = 1.35, 95% confidence interval = 1.35–1.73). The risk of CKD was 1.35-fold higher in participants with bevacizumab treatment than those in the control group. These findings suggest that close monitoring of CKD development after bevacizumab administration is needed.

The impact of sodium-glucose cotransporter 2 inhibitors (SLGT2i) usage on reducing the risk of dementia remains uncertain. Our research seeks to establish

Aims: Evidence showed that SGLT2 inhibitors have greater protective effects against retinal diseases compared to other hypoglycemic agents. Thus, we explore the association between SGLT2 inhibitor usage and macular degeneration (MD) in Taiwanese patients with diabetes. Methods: The National Health Insurance (NHI) program's claim data are released as the National Health Insurance Research Database (NHIRD). This database covers more than 99% of the residents in Taiwan. We included data on patients who were newly diagnosed with type 2 diabetes mellitus (ICD-9-CM: 250, exclude 250.1x; ICD-10-CM: E11), with an age at diagnosis of over 20 years as our study population. Patients who received (sodium-glucose cotransporter 2 inhibitor) SGLT2i (ATC code: A10BK) over 90 days in 2016–2019 were defined as the SGLT2i cohort. Conversely, patients who did never received SGLT2i were defined as the non-SGLT2i cohort. The exclusion criteria were having MD before the index date, receiving SGLT2i within 1–89 days, and missing data on sex, age, or days of SGLT2i usage. Two cohorts were matched by 1:1 propensity score matching, which was based on age, sex, payroll bracket grade, urbanization, comorbidities, and medications. Results: Compared to non-SGLT2i cohort, patients who received SGLT2i had a significantly lower risk of MD (adjusted hazard ratio = 0.70, 95%CI = 0.66–0.75). Conclusions: We found that SGLT2is has a strong protective effect against MD in patients with diabetes. SGLT2is may have benefits beyond glycemic control in patients with DR. However, additional clinical and experimental studies are required.

Systemic vascular endothelial growth factor (VEGF) blockade has been the top adjunctive chemotherapy since 1990. Anti-VEGF therapy has also been associated with worsened renal function in some patients. However, the association between patient outcomes and use of intravitreal VEGF inhibitors remains controversial. Thus, it is necessary to determine the action mechanism and long-term renal effects of ranibizumab. The National Health Insurance Research Database (NHIRD) is one of the largest global databases that are extensively used for epidemiological research. NHIRD contains the medical information of all insureds, such as inpatient, outpatient, emergency, and traditional Chinese medicine records. We selected subjects aged ≥ 20 years who recently administered ranibizumab for the ranibizumab cohort. Non-ranibizumab cohort consisted of subjects who did not receive ranibizumab, and the index date was a random date between 2008 and 2018. We excluded subjects with missing sex and age records and those in which the date of primary outcome was before the index date. The two cohorts were matched via 1:1 propensity score matching based on sex, age, index year, hypertension, diabetes mellitus, hyperlipidemia, stroke, coronary artery disease, alcoholism, chronic obstructive pulmonary disease, and age-related macular degeneration, retinal vein occlusion, and diabetic macular edema. Medical confounders were angiotensin I-converting enzyme inhibitors, statins, corticosteroids, VEGF inhibitors including bevacizumab and aflibercept, lithium, amphotericin B, adefovir, NSAIDS, cisplatin, and calcineurin inhibitors. Among 48,248 participants aged ≥ 20 years, 24,136 (50%) received ranibizumab (13,565 male [56.20%] and 10,571 female [43.80%]). Moreover, 24,136 participants who did not receive ranibizumab were matched by age, sex, comorbidities, and medications. Subjects who received ranibizumab exhibited a significantly higher risk of CKD than those who did not receive ranibizumab (adjusted hazard ratio = 1.88, 95% CI = 1.79–1.96). Our findings revealed that exposure to intravitreal ranibizumab is an independent risk factor for CKD. Therefore, physicians and ophthalmologists should make the patients aware of such a correlation to increase patient safety and decrease the CKD burden.

(1) Background: The role of air pollutants as risk factors for tinnitus remains unclear. To address this gap in research, we conducted a nationwide retrospective cohort study in Taiwan by integrating patients’ clinical data with daily air quality data to evaluate the environmental risk factors associated with tinnitus. (2) Methods: The Taiwan National Health Research Database (NHIRD) includes medical records for nearly all residents of Taiwan. To assess pollution levels, we used daily air quality data from the Taiwan Environmental Protection Agency regarding SO₂, CO, NO, NO_X, and particulate matter (PM_2.5 and PM₁₀). We merged the NHIRD data with air quality information based on the residents’ locations and the positions of air quality monitoring stations. Pollutant levels were then categorized into quartiles (Q1, Q2, Q3, and Q4). (3) Results: This study included 284,318 subjects. After controlling for covariates, the adjusted HR (95 CI%) for tinnitus increased with increasing SO₂, CO, NO, NO_X, PM_2.5, and PM₁₀ exposure levels, specifically from 1.24 (95 CI% = 1.18, 1.30) to 1.35 (95 CI% = 1.28–1.41); from 1.15 (95 CI% = 1.09, 1.21) to 1.90 (95 CI% = 1.81, 2.00); from 0.86 (95 CI% = 0.82, 0.91) to 1.69 (95 CI% = 1.62, 1.77); from 1.62 (95 CI% = 1.54, 1.71) to 1.69 (95 CI% = 1.60, 1.77); from 0.16 (95 CI% = 0.15, 0.18) to 2.70 (95 CI% = 2.57, 2.84); and from 2.53 (95 CI% = 2.38, 2.69) to 3.58 (95 CI% = 3.39, 3.78), respectively, compared to the Q1 concentrations for all air pollutants. (4) Conclusions: During the 15-year follow-up period, we found a significant positive correlation between air pollutant exposure and the risk of tinnitus.

Abatract: Background : Sensorineural hearing loss (SNHL) is a common but underrecognized complication of type 2 diabetes mellitus (T2DM). Sodium-glucose cotransporter-2 inhibitors (SGLT2i) use was associated with favorable renal and cardiovascular outcomes beyond glycemic control, but their impact on auditory outcomes remains unclear. Methods: We conducted a nationwide cohort study using Taiwan’s National Health Insurance Research Database (2000–2021). Patients with T2DM who received SGLT2i for ≥ 90 days were compared with matched non-users. Propensity score matching was applied 1:1 based on demographic, clinical, and treatment characteristics. The primary outcome was the incidence of SNHL, confirmed by audiometric testing. Results: A total of 381,592 patients with type 2 diabetes mellitus (T2DM) were included. Compared with non-users, SGLT2i users exhibited a significantly lower risk of SNHL (adjusted hazard ratios (aHRs) = 0.84; 95% CI: 0.75–0.94). Subgroup analyses confirmed a consistent lower risk across sex, age, urbanization, and comorbidity strata. Notably, long-term SGLT2i use (≥ 366 days) showed a strong dose–response association with reduced SNHL risk (aHR = 0.32; 95% CI: 0.27–0.39). Conclusion: SGLT2i use in T2DM patients is associated with a reduced risk of SNHL, particularly with sustained therapy. These findings highlight a potential association between SGLT2i use and a lower risk of auditory complications in diabetes, underscoring the importance of considering hearing health within comprehensive diabetes management.