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Abstract: SA-PO1225

CKD Outcomes Among Patients Treated with Immune Checkpoint Inhibitors

Session Information

Category: Onconephrology

  • 1600 Onconephrology

Authors

  • Mistry, Kavita, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Synnott, David, Beaumont Hospital, Dublin, Leinster, Ireland
  • Ouyang, Tianqi, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Bharati, Joyita, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Mejia, Sherley M., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Moreno, Daiana R., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Cao, Andrew, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Kirkpatrick, Anna S., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Gupta, Shruti, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Chewcharat, Api, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Zubiri Oteiza, Leyre, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Reynolds, Kerry, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Moledina, Dennis G., Yale School of Medicine, New Haven, Connecticut, United States
  • Sise, Meghan E., Massachusetts General Hospital, Boston, Massachusetts, United States
Background

Immune checkpoint inhibitors (ICIs) cause acute interstitial nephritis in 3-5% of patients; however, little is known about chronic kidney disease (CKD) outcomes in cancer survivors. We sought to determine the incidence and risk factors for progressive CKD in long-term cancer survivors exposed to ICIs and to characterize linkage to nephrology care.

Methods

Retrospective cohort study of adult patients beginning ICIs at two cancer centers from 2010-2024. The primary outcome of progressive CKD was a composite of incident CKD (>25% eGFR decline to <60 mL/min/1.73 m2 for >90 days), CKD progression (≥30% eGFR decline from baseline for >90 days), or kidney failure (eGFR<10 for >90 days, KRT or transplant). We determined the association between baseline comorbidities and the primary outcome using a cause-specific proportional hazards model, accounting for the competing risk of death. Linkage to care among patients who developed progressive CKD and survived ≥5 years was defined using chart review to determine outpatient visits, lab tests, blood pressure and medications.

Results

Of 25,397 patients who began ICIs, the rate of progressive CKD is shown by year of follow-up (Fig1A). Risk factors for progressive CKD in adjusted models include age (aHR 1.34 per 10 yrs, 95%CI=1.23–1.40, p<0.001), female sex (aHR 1.32, 95%CI=1.15–1.49, p<0.001), diabetes (aHR 1.34, 95%CI=1.15–1.57, p<0.001), proton pump inhibitor use (aHR 1.26, 95%CI=1.09–1.46, p=0.002), and lower baseline eGFR (aHR 1.11 per 10mL/min decline, 95%CI=1.08–1.15, p<0.001). Among 1,110 patients who met the primary outcome, 450 (41%) had an AKI event prior to progressive CKD. Of the patients who survived and were followed >5 years, 256 (15.4%) developed progressive CKD, but only 52 had ongoing nephrology care and there were marked shortfalls in risk factor control (Fig1B-E).

Conclusion

Progressive CKD is common in patients with cancer exposed to ICIs. The majority of patients with progressive CKD do not receive ongoing nephrology care according to guidelines, underscoring the need to improve survivorship care.

Funding

  • NIDDK Support