Kidney Week

Abstract: SA-PO1263

Antineoplastic Agents and Worsening Proteinuria: The Impact of Baseline Proteinuria

Session Information

• Onconephrology: Epidemiological Trends, Risk Stratification, and Clinical Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Onconephrology

• 1600 Onconephrology

Authors

• Kobayashi, Norihiro, Kinki Daigaku Byoin, Sakai, Osaka Prefecture, Japan

Norihiro Kobayashi, DrMed

• Murashima, Miho, Kinki Daigaku Byoin, Sakai, Osaka Prefecture, Japan

Miho Murashima, MD, PhD

• Manabe, Shohei, Kinki Daigaku Byoin, Sakai, Osaka Prefecture, Japan

Shohei Manabe, MD

• Okada, Nobutaka, Kinki Daigaku Byoin, Sakai, Osaka Prefecture, Japan

Nobutaka Okada, MD

• Nakatani, Yoshihisa, Kinki Daigaku Byoin, Sakai, Osaka Prefecture, Japan

Yoshihisa Nakatani, MD, MEd, PhD

• Arima, Shuji, Kinki Daigaku Byoin, Sakai, Osaka Prefecture, Japan

Shuji Arima, MD, PhD

Background

Significant proteinuria may interrupt treatment for malignancy or cause urinary loss of therapeutic antibodies. This study aims to identify antineoplastic agents associated with worsening proteinuria and investigate the impact of baseline proteinuria.

Methods

In this retrospective cohort study, we enrolled patients treated with antineoplastic agents from 2018 to 2023 at Kindai University Hospital. Outcome was worsening proteinuria, defined by an increase in dipstick proteinuria by 2 grades or doubling of urine protein-to-creatinine ratio (UPCR).
Covariates were selected by the least absolute shrinkage and selection operator regression. A multilevel mixed-effects logistic regression model with individual patients and malignancies as random effects was used to identify antineoplastic agents associated with proteinuria. The associations of baseline proteinuria defined as dipstick proteinuria 1+ or more or UPCR > 1 g/gCr with worsening proteinuria were evaluated using Kaplan–Meier curves and Cox proportional hazards models. Sensitivity analysis was performed with competing risk regression, in which death was treated as a competing risk.

Results

Of 10,784 patients treated with antineoplastic agents, 8,692 had urine dipstick data available. Worsening proteinuria occurred in 3,153. Vascular endothelial growth factor-tyrosine kinase inhibitors (VEGF-TKIs), anti-VEGF antibodies, and immune checkpoint inhibitors (ICIs) were associated with worsening proteinuria (adjusted OR [95% CI] 4.01 [3.30-4.87], 2.72 [2.37-3.11], and 1.58 [1.37-1.83], respectively), and these associations were dose-dependent. Baseline proteinuria was not associated with a higher incidence of dipstick-defined its worsening among users of anti-VEGF antibodies, VEGF-TKIs, or ICIs (HR [95% CI]; 0.22 [0.13-0.36], 0.47 [0.27-0.84], and 0.15 [0.07-0.29], respectively]. The results were similar when the outcome was defined as doubling of UPCR, or analyses were performed using competing-risk model.

Conclusion

VEGF-pathway inhibitors and ICIs were associated with worsening proteinuria.
Baseline proteinuria was not associated with the risk of worsening proteinuria. Our findings suggest that these agents may be prescribed to patients with baseline proteinuria under careful monitoring.