Abstract: SA-PO199
AKI Associated with Immune Checkpoint Inhibitor Therapy: Incidence, Risk Factors, and Outcomes
Session Information
- Onco-Nephrology: Clinical
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onco-Nephrology
- 1500 Onco-Nephrology
Authors
- Meraz-Munoz, Alejandro Y., University Health Network, Toronto, Ontario, Canada
- Amir, Eitan, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Chan, Christopher T., University Health Network, Toronto, Ontario, Canada
- Hogg, David, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Wald, Ron, St. Michael's Hospital, Toronto, Ontario, Canada
- Kitchlu, Abhijat, University Health Network, Toronto, Ontario, Canada
Background
Immune checkpoint inhibitors (ICI) are a novel and promising anti-cancer therapy. There is limited data on the incidence, risk factors and outcomes of acute kidney injury (AKI) in patients receiving ICI.
Methods
We conducted a retrospective cohort study of patients receiving ICI at our center between 2010 and 2017 via electronic health record. The primary outcome was AKI [an increase of at least 50% from baseline serum creatinine (sCr)]. Risk factors for AKI were assessed using logistic regression. Survival among those with and without AKI was compared using time-to-event analysis.
Results
Among 309 patients on ICI, 52 (17%) developed AKI (KDIGO Stages 1: 9%, 2: 4%, 3: 4%). AKI was associated with other immune-related adverse events (IRAE) [odds ratio (OR) 3.2 (95%CI: 1.6-6.1), p <0.001], hypertension [4.3 (1.8-6.1), p<0.001] and cerebrovascular disease [9.2 (2.1-40.0), p<0.001]. Baseline sCr, cancer and ICI type were not associated with AKI. Use of ACEi/ARB [OR 2.9 (1.5-5.7), p =0.002], diuretic [OR 4.3 (1.9-9.8), p <0.001] and corticosteroid treatment [OR 1.9 (1.1-3.6), p =0.03] were associated with AKI. In the multivariable analysis, AKI was associated only with other IRAE [2.82 (1.45-5.48) p=0.002] and hypertension [2.96 (1.33-6.59), p=0.008]. AKI was not associated with increased risk of mortality [hazard ratio 1.1 (0.8-1.6, p =0.67). ICI nephrotoxicity was attributed via biopsy or nephrologist assesment in 12 patients (6 intersitial nephritis, 2 membranous nephropathy, 2 minimal change disease, 2 thrombotic microangiopathy). Re-challenge with ICI occurred in 12 patients with AKI, 1 (8.3%) had recurrent AKI.
Conclusion
AKI incidence during ICI therapy may be greater than previously reported and several etiologies must be considered. A minority of patients undergo kidney biopsy.The development of other IRAE is associated with AKI risk. AKI was not associated with worse cancer survival.