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Abstract: PO0024

Independent Predictors of Checkpoint Inhibitor-Associated AKI

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Bolufer, Mónica, Vall d Hebron, Barcelona, Cataluña, Spain
  • García-Carro, Clara, Vall d Hebron, Barcelona, Cataluña, Spain
  • Bury, Roxana, Vall d Hebron, Barcelona, Cataluña, Spain
  • Muñoz, Eva, Vall d Hebron, Barcelona, Cataluña, Spain
  • Felip, Enriqueta, Vall d Hebron, Barcelona, Cataluña, Spain
  • Gabaldon, Alejandra, Vall d Hebron, Barcelona, Cataluña, Spain
  • Carreras, Maria Josep, Vall d Hebron, Barcelona, Cataluña, Spain
  • Serón, Daniel, Vall d Hebron, Barcelona, Cataluña, Spain
  • Soler, Maria Jose, Vall d Hebron, Barcelona, Cataluña, Spain
Background

Checkpoint inhibitors(CPI)–associated acute renal injury(AKI) is an adverse effect of these therapies and its incidence is 13-29%. Clinical characteristics and risk factors of CPI-associated AKI were investigated

Methods

Clinical and demographic data of patients receiving CPI March2018-May2019 were evaluated. Patients were divided into two groups depending on the development of AKI.

Results

821 patients received CPIs.Mean age 62.03±12.06 and 486(59.2%) men. Malignancies: lung 249(30.3%), urogenital tract 168(20.5%), melanoma 89(10.8%) and others 315(38.4%). 446(54.3%) anti-PD1, 230(28%) anti-PDL1, 13(1.6%) anti-CTLA4, 36(4.4%) other drug and 96(11.7%) both anti-CTLA4 and anti-PD1 or anti.PDL1.Baseline creatinine(bCr) 0.85±0.30 mg/dL and 188(22.9%) Cr>1mg/dL before starting CPI.125 (15.2%) developed AKI, 85(68%) men and mean age 65.1±10.7.Baseline Cr 0.97±0.45 mg/dL and 44(35.2%) presented bCr>1mg/dL.Cr at AKI diagnosis 2.27±1.34mg/dL and two required haemodialysis. 5 AKI secondary to obstructive uropathy. Time from CPI initiation to AKI 5.6±5.8months. Of those 125 patients, 23(18.4%) referred to Nephrology and 9(7.2%) underwent kidney biopsy. 1 endocapillar non-CPI related glomerulonephritis and 8(6.4%) acute tubule-interstitial nephritis(ATIN). 23(18.4%) were treated with corticosteroids. Cr at 6months after AKI 1.04±0.34 mg/dl and 40 showed complete recovery of kidney function at 6 months. AKI stage 2 or 3 were lower bCr(0.86±0.25 vs 1.06±0.54 mg/dL,p=0.01), increased latency from CPI initiation to AKI(6.9±6vs 4.5±5.5 months,p=0.03) and worse recovery of kidney function at 6 months than AKI patients stage 1(Cr 1.18±0.40 mg/dL, p=0.04 and complete recovery of kidney function 70.5%vs 93.3%,p=0.03). AKI patients were older (65.1±10.7 vs 62.03±12.06years,p=0.01), male (68%vs57.9%),p=0.03) and higher bCr(0.97±0.45 vs 0.85±0.30 mg/dL,p<0.01), bCr>1mg/dL (35.2%vs20.7%,p=0.04). Older age (OR 1.020, CI 95%1.002-1.038) and bCr(OR 3.293, CI 95% 1.678-6.461) were identified as independent predictors of AKI development in CPI

Conclusion

CPI-associated AKI is 15.2%,44% developed severe AKI.18.4% were referred to a nephrologist and kidney biopsy performed in 7.2%. 18.4% received corticosteroids. Older age and higher bCr were identified as independent predictors for AKI development in patients with cancer CPI-treated