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Abstract: FR-PO237

Incidence of AKI with Immune Checkpoint Inhibitors: A Five-Year Retrospective Review

Session Information

Category: Onconephrology

  • 1700 Onconephrology


  • O'Connell, Blathnaid, University Hospital Waterford, Waterford, Waterford, Ireland
  • Brown, Catherine M., University Hospital Waterford, Waterford, Waterford, Ireland

Immune checkpoint inhibitors (ICPIs) are one of the most commonly prescribed cancer treatments. ICPIs prolong overall & progression-free survival in patients with a wide range of malignancies, but also cause AKIs. This can lead to dose delays, discontinuation of therapy, and prolonged courses of immunosuppression.The reported rate of ICPI-AKI is variable, ranging from 3%-7%.
Use of ICPIs has increased significantly in recent years. The aim of this study was to describe the incidence & stages AKI associated with ICPIs, over a 5 year period.


Patients receiving ICPIs between 2016-2021 in University Hospital Waterford (UHW), were identified using the UHW oncology database.
Data were then linked to our institutional electronic patient record to obtain laboratory data and kidney biopsy results. Medical charts were reviewed to obtain data on concurrent medications and treatment received for ICPI-AKIs.
AKI was defined as per the KDIGO criteria.


202 patients commenced ICPIs, with a mean age of 69 & a male preponderance (1.6:1).
20.3% of patients experienced an AKI, & of those, 19.5% had eosinophilia. The incidence of AKI & eosinophilia differed by agent .
AKI rates differed by agent; Pembrolizumab 21.2%, Nivolumab 20.9%, atezolizumab 10.8%, durvalumab 33.3% & ipilimumab 33.3%. Anti-CTL4 ICPIs had a higher rate of AKI compared to PD-1 ICPIs at 25% & 21%.
83% had a stage 1 AKI, 7% had a stage 2 AKI & 10% had a stage 3 AKI. Stages differed by agent.
71.4% with a stage 2 or 3 AKI received steroids, & 1 patient received infliximab. Only 1 patient had a renal biopsy, reporting ATN.
The average time to develop an AKI was 85.7 days (ranging 7 to 314 days).


This demonstrates a considerable burden of AKI in patients on ICPis. Incidence of AKI in our cohort is higher than previously reported, at 20.3%, but the majority were stage 1.
Only 1 patient underwent a biopsy. Previously, biopsies were the standard of care, however current ASCO guidelines recommend empiric treatment.
A high index of suspicion should be maintained throughout duration of treatment, even in patients established on ICPIs, due to the variation in time to develop an AKI after treatment initiation.
The use of ICPIs is increasing & it is important to monitor for renal toxicity. Close monitoring of renal function, early recognition & management of AKI can prevent long-term renal damage and improve outcomes.