Abstract: TH-OR02
AKI in Patients Treated with Immune Checkpoint Inhibitors
Session Information
- AKI: Pathways, Predictors, and Prevention
November 04, 2021 | Location: Simulive, Virtual Only
Abstract Time: 04:30 PM - 06:00 PM
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.