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: FR-PO214

Renal Adverse Events Associated With the Immune Checkpoint Inhibitor Therapy: A Systematic Review and Bayesian Network Meta-Analysis of 96 Randomised Controlled Trials

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Trisal, Shehjar, University of Sydney - Camperdown and Darlington Campus Burkitt-Ford Library, Sydney, New South Wales, Australia
  • Low, Gary Kk, University of Sydney - Camperdown and Darlington Campus Burkitt-Ford Library, Sydney, New South Wales, Australia
  • Pathan, Faraz Khalid, University of Sydney - Camperdown and Darlington Campus Burkitt-Ford Library, Sydney, New South Wales, Australia
  • Gangadharan Komala, Muralikrishna, University of Sydney - Camperdown and Darlington Campus Burkitt-Ford Library, Sydney, New South Wales, Australia
Background

Immune checkpoint inhibitors (ICI) have revolutionised cancer immunotherapy, improving survival in cancer patients. However, the blockade of immune regulatory sites, CTLA-4, PD-1, and PD-L1 is associated with a range of immune related adverse events (irAE) of which renal irAE occur infrequently and are not regularly reported.

Methods

The PRISMA guidelines were used to search for Randomised Control Trials (RCT) reporting severe adverse renal events across five electronic databases from inception to April 2022. This was supplemented with hand searching of major medical journals and the National Clinical Trials registry. A Bayesian network meta-analysis was performed using R version 4.1.0 R for the following outcomes: acute kidney injury (AKI), hypertension (HTN), glomerulonephritis, chronic kidney disease (CKD) and the composite of all acute adverse renal events (AARE) namely AKI, HTN and glomerulonephritis. Network meta-regression was performed to adjust for inconsistencies arising from malignancy subtype.

Results

96 RCTs reported severe grade adverse renal events. The risk of developing acute kidney injury is higher among patients who received PD-1 plus chemotherapy (OR 1.8 [95% CrI 1.3 to 2.4]) and PD-L1 plus chemotherapy (OR 1.90 [95% CrI 1.3 to 2.9]) when compared to standard chemotherapy and placebo (95 studies, 63, 793 participants). The risk of developing an AARE is higher among patients who received PD-1 plus chemotherapy (OR 1.7 [95% CrI 1.1 to 2.4]) and PD-L1 plus chemotherapy (OR 1.7 [95% CrI 1.1 to 2.6) when compared to standard chemotherapy and placebo (64,409 participants).

Conclusion

The combined regimen of PD-1 or PDL-1 + chemotherapy is associated with higher incidence of severe grade AKI and AARE. Prescription of combined therapy will warrant closer monitoring and implementation of preventive strategies/changes to the treatment regimen could be arranged early at the onset of adverse events.

Incidence of Acute Kidney Injury