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Kidney Week

Abstract: PO0261

AKI and Mortality in Patients Prescribed Immune Checkpoint Inhibitor Therapy

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Baker, Megan Leila, Yale University Department of Internal Medicine, New Haven, Connecticut, United States
  • Yamamoto, Yu, Yale University Department of Internal Medicine, New Haven, Connecticut, United States
  • Perazella, Mark A., Yale University Department of Internal Medicine, New Haven, Connecticut, United States
  • Parikh, Chirag R., Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Wilson, Francis Perry, Yale University Department of Internal Medicine, New Haven, Connecticut, United States
  • Moledina, Dennis G., Yale University Department of Internal Medicine, New Haven, Connecticut, United States
Background

In patients on immune checkpoint inhibitor (ICI) therapy, acute kidney injury (AKI) is relatively common, and can occur from tubular injury or pre-renal azotemia unrelated to ICI use, or from off-target immune activation resulting in acute interstitial nephritis (AIN). The association of AKI and its specific etiologies with mortality is not known.

Methods

In participants initiated on ICI between 2013-2019, we tested the association of serum creatinine-based AKI with mortality up to 1 year after therapy initiation using Cox proportional hazard models controlling for demographics, comorbidities, cancer type, severity, therapy, and baseline laboratory values. In patients with AKI, we tested the association of AKI severity, AKI duration, and, using a validated risk score, AIN risk with mortality.

Results

Of 2,207 patients initiated on ICI therapy, 549 (25%) developed AKI. Mortality rate was higher in those who developed AKI (905 vs. 445 per 1000 person-years). AKI was independently associated with higher mortality [adjusted HR, 2.18 (95% CI, 1.38-3.45)] and this hazard was highest in the first month after AKI [9.7 (7.8-12.1)] and progressively diminished to the background rate by four months. Among patients with AKI, mortality was higher in those with severe AKI [2.03 (1.01-4.11)] and longer duration AKI [2.58 (1.01-6.60)], but lower in those with the highest likelihood of AIN [adjusted HR highest vs. lowest tertile, 0.07 (0.02-0.29)].

Conclusion

We noted that occurrence of AKI was independently associated with higher mortality in patients treated with ICI. Among patients with AKI, mortality was higher in those with severe AKI and longer duration AKI, but lower in those with features suggestive of AIN.

Funding

  • Other NIH Support