Abstract: TH-PO0174
Immunotherapy-Associated Kidney Dysfunction in Metastatic Cancer: An Emerging Concern in Onconephrology
Session Information
- Onconephrology: Anticancer Therapies, PTLD, Paraneoplastic Diseases, and More
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Onconephrology
- 1700 Onconephrology
Authors
- Trevisani, Francesco, IRCCS Ospedale San Raffaele, Milan, Lombardy, Italy
- Angioi, Andrea, Azienda Ospedaliera Brotzu, Cagliari, Sardinia, Italy
- Floris, Matteo, Azienda Ospedaliera Brotzu, Cagliari, Sardinia, Italy
- Izzo, Davide, Istituto Europeo di Oncologia, Milan, Lombardy, Italy
- Marsicano, Renato Maria, Istituto Europeo di Oncologia, Milan, Lombardy, Italy
- Denaro, Nerina, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardy, Italy
- Garrone, Ornella, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardy, Italy
- Tomasello, Gianluca, ASST Crema, Crema, Italy
- Ghidini, Michele, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardy, Italy
Background
Immune checkpoint inhibitors (ICIs) have transformed the management of metastatic cancers, yet their nephrotoxic potential remains underappreciated. While acute kidney injury (AKI) is a known immune-related adverse event, the subacute spectrum of kidney injury—termed acute kidney disease (AKD)—has not been adequately explored in this setting.
Methods
We conducted a retrospective cohort study of 226 adult patients with metastatic solid tumors who received ICIs between 2006 and 2023 at a single tertiary care center. AKD was defined according to the 2024 KDIGO criteria. Multivariable logistic regression was used to identify predictors of AKD.
Results
AKD occurred in 46 patients (20.4%) within 90 days of ICI initiation, with 16 (7.1%) experiencing persistent dysfunction beyond 30 days. Independent predictors of AKD included higher body surface area (OR 8.17, p = 0.03) and baseline use of nonsteroidal anti-inflammatory drugs (OR 29.74, p = 0.014). Baseline antibiotics showed a trend toward association (p = 0.054). Concurrent chemotherapy was associated with a trend toward protection. The predictive model showed good discrimination (AUC 0.778). No significant differences in other grade ≥2 immune-related adverse events were observed between AKD and non-AKD groups.
Conclusion
AKD is a frequent and underrecognized renal complication in patients receiving ICIs, with implications for both renal and oncologic outcomes. Identifying high-risk patients and integrating longitudinal renal monitoring into immunotherapy care pathways may improve safety and treatment continuity.