ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: TH-OR02

AKI in Patients Treated with Immune Checkpoint Inhibitors

Session Information

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Authors

  • Gupta, Shruti, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Leaf, David E., Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States

Group or Team Name

  • ICPi-AKI Consortium
Background

Data on immune checkpoint inhibitor-associated acute kidney injury (ICPi-AKI) are largely limited to single-center case series. We performed a multicenter study, the largest to date, to investigate risk factors, clinicopathologic features, outcomes, and survival in patients with ICPi-AKI.

Methods

We collected detailed data on 429 patients with ICPi-AKI and 429 controls who received ICPis contemporaneously but did not develop ICPi-AKI from 30 international sites. Multivariable logistic regression was used to identify predictors of ICPi-AKI and its recovery.

Results

ICPi-AKI occurred at a median of 16 weeks (IQR, 8-32) following ICPi initiation. Lower baseline eGFR, proton pump inhibitor (PPI) use, and prior or concomitant extrarenal immune-related adverse events (irAEs) were associated with a higher risk of ICPi-AKI (Figure A). Acute tubulointerstitial nephritis was the most common lesion on biopsy (125/151 biopsied patients [82.7%]). Hematuria, pyuria, and proteinuria were present in only 30-60% of patients with ICPi-AKI, and were more common in patients with greater severity of AKI. Renal recovery occurred in 276 patients (64.3%) at a median of 7 weeks (IQR, 3-10) following ICPi-AKI. Treatment with steroids was associated with higher odds of renal recovery (adjusted OR, 1.81; 95% CI, 1.01-3.27) (Figure B), particularly when initiated within 3 days of ICPi-AKI diagnosis (adjusted OR, 1.77; 95% CI, 1.01-3.13). Steroid use was also associated with a lower risk of death (adjusted HR, 0.52; 95% CI, 0.36-0.75). Of 121 patients rechallenged, only 20 (16.5%) developed recurrent ICPi-AKI.

Conclusion

Lower baseline eGFR, PPI use, and extrarenal irAEs are each independent risk factors for ICPi-AKI. Two thirds of patients have renal recovery following ICPi-AKI. Early treatment with steroids is associated with renal recovery and better overall survival.