Abstract: SA-OR001
Multicenter Study of Immune Checkpoint Inhibitor-Associated AKI
Session Information
- AKI: Onco-Nephrology and Other Drugs
November 09, 2019 | Location: Salon A/B, Walter E. Washington Convention Center
Abstract Time: 04:30 PM - 04:42 PM
Category: Onco-Nephrology
- 1500 Onco-Nephrology
Authors
- Kibbelaar, Zoé A., Brigham and Women's Hospital, Boston, Massachusetts, United States
- Cortazar, Frank B., Massachusetts General Hospital, Boston, Massachusetts, United States
- Leaf, David E., Brigham and Women's Hospital, Boston, Massachusetts, United States
Group or Team Name
- ICPi-AKI Working Group
Background
Immune checkpoint inhibitor-associated AKI (ICPi-AKI) is an increasingly frequent complication of immunotherapy. However, existing data on ICPi-AKI are limited to small, mostly single-center studies.
Methods
We contacted nephrologists and oncologists at >20 major cancer centers across the U.S. and Canada, and identified 138 patients from 18 institutions with ICPi-AKI. All patients were required to have at least a doubling of serum creatinine or need for dialysis, along with a clinical diagnosis of ICPi-AKI by the provider. Detailed data were collected using a standardized case report form. We also collected data on 276 control patients who received ICPis but did not develop AKI. Multivariable logistic regression was used to determine risk factors for development of ICPi-AKI and prognostic factors for its recovery.
Results
Lower baseline eGFR, concomitant use of a PPI, and combination ICPi therapy were each associated with a greater risk of ICPi-AKI. The median time from initiation of an ICPi to AKI was 14 (IQR, 6–37) weeks. An extra-renal immune-related adverse event (irAE) occurred concomitantly with AKI in 43% of patients. Most patients had proteinuria and pyuria. A kidney biopsy was obtained in 43% of patients, with acute interstitial nephritis (AIN) found in 93%. Overall, 87% of patients were treated with steroids, of whom 43%, 43%, and 13% had complete, incomplete, and no renal recovery, respectively. Concomitant extra-renal irAEs were associated with worse renal prognosis, while concomitant AIN-causing medications and treatment with steroids were associated with improved renal prognosis. ICPi re-challenge occurred in 22% of patients, of whom 23% developed recurrence of AKI.
Conclusion
Using a multicenter approach, we present the largest clinical study to date to describe the clinical and pathologic features of ICPi-AKI.