Abstract: PO2161
A Single-Center Cohort Study of Nephrotoxicity due to Immune Checkpoint Inhibitors
Session Information
- Onco-Nephrology - 1
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Onco-Nephrology
- 1500 Onco-Nephrology
Authors
- Irwin, Craig Thomas, Marshfield Clinic Health System, Marshfield, Wisconsin, United States
- Panic, Jennifer, Marshfield Clinic Health System, Marshfield, Wisconsin, United States
- Lodhi, Fahad Aftab khan, Marshfield Clinic Health System, Marshfield, Wisconsin, United States
- Lee, Joshua T., Marshfield Clinic Health System, Marshfield, Wisconsin, United States
- Elkhidir, Sabri Elamin abbas, Marshfield Clinic Health System, Marshfield, Wisconsin, United States
- Folz, Connie M., Marshfield Clinic Health System, Marshfield, Wisconsin, United States
- Pulipati, Soumya, Marshfield Clinic Health System, Marshfield, Wisconsin, United States
- Bissonnette, Adam M., Marshfield Clinic Health System, Marshfield, Wisconsin, United States
- Fatima, Zebi, Marshfield Clinic Health System, Marshfield, Wisconsin, United States
- Blonsky, Rebecca, Marshfield Clinic Health System, Marshfield, Wisconsin, United States
- Leon, Chady A., Marshfield Clinic Health System, Marshfield, Wisconsin, United States
- Kattamanchi, Siddhartha, Marshfield Clinic Health System, Marshfield, Wisconsin, United States
Background
Previous studies and case reports have demonstrated an increased risk of nephrotoxicity in patients receiving immune checkpoint inhibitors (CPIs) compared to clinical trials. The primary objective of this study was to contribute to the existing data regarding the frequency, causes of, and risk factors for CPI-induced AKI.
Methods
This was a retrospective cohort study of patients receiving at least one dose of a CPI at a health system in Central Wisconsin from 2013 to 2019. Baseline serum creatinine, defined as the average of all values obtained within 6 months of the CPI start date, was compared to all serum creatinine measurements during CPI therapy and through 60 days after the last CPI dose. Patients developing an AKI of at least three day duration were further assessed to determine the likely cause of AKI, with the incidence of potentially CPI-induced AKI being our primary outcome.
Results
A total of 936 patients received at least one dose of a CPI at MCHS during the study period. After applying exclusion criteria, a total of 910 patients were included in the analysis. A total of 8.4% of patients (76 of 910) were on dual CPI therapy (ipilimumab and nivolumab). The incidence of AKI of any duration was 36.6% (333 of 910 patients), while sustained AKI (defined as 3 days or longer or not re-measured) occurred in 31.0% of patients (282 of 910). The incidence of presumed CPI-induced AKI was 3.2% (29/910). A total of 25.2% (71/282) of sustained AKI patients had at least one concurrent immune-related adverse effect (irAE), compared to 55.2% (16/29) of presumed CPI-induced AKI. CPI-induced AKI occurred on average 88.2 days (standard deviation 80.6) after starting the CPI, with several AKI events occurring within 60 days after stopping the CPI.
Conclusion
AKI secondary to CPI is a common side effect of CPI. In our population, it occurred at an incidence of 3.2% and sometimes occurred even after the last dose of CPI. The etiology of AKI in almost all cases of biopsy-proven CPI-induced AKI is acute interstitial nephritis. The risk appears to be increased if a patient has already developed an irAE.
Funding
- Private Foundation Support