Kidney Week

Abstract: SA-PO1235

Electrolyte Disturbances in Patients with Cancer Treated with Immune Checkpoint Inhibitors: A Systematic Review and Meta-Analysis

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

• Hannouneh, Zein Alabdin, Hennepin Healthcare System Inc, Minneapolis, United States

Zein Alabdin Hannouneh, MD

• Issa, Muhsen, Al Andalus University Faculty of Medicine, Tartus, Syrian Arab Republic

Muhsen Issa, MD

• Bashour, George, University of Warwick, Coventry, England, United Kingdom

George Bashour, MD, MSc

• Attaf, Ram, Al Andalus University Faculty of Medicine, Tartus, Syrian Arab Republic

Ram Attaf

• Ashour, Reham, Department of Internal Medicine, Al-Mowassat Hospital, Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic

Reham Ashour

• Haddad, Saddik, Latakia University Faculty of Medicine, Latakia, Syrian Arab Republic

Saddik Haddad, MD

• Alahdab, Gieth, Eye Research Center and Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, Michigan, United States

Gieth Alahdab, MD

• Hijazi, Amjad, UPMC Magee-Women's Hospital, Pittsburgh, Pennsylvania, United States

Amjad Hijazi

• Abdelaal, Abdelrahman Akram, Mansoura University Faculty of Medicine, Mansoura, Dakahlia, Egypt

Abdelrahman Akram Abdelaal, MBBS

• Jendi, Rayan, Al Andalus University Faculty of Medicine, Tartus, Syrian Arab Republic

Rayan Jendi

• Saleh, Ibrahim, Al Andalus University Faculty of Medicine, Tartus, Syrian Arab Republic

Ibrahim Saleh, MD

• Kheyrbek, Nina, Latakia University Faculty of Medicine, Latakia, Syrian Arab Republic

Nina Kheyrbek, MD

• Hmidoush, Ali, Latakia University Faculty of Medicine, Latakia, Syrian Arab Republic

Ali Hmidoush, MD

• Hannouneh, Halla, Al Andalus University Faculty of Medicine, Tartus, Syrian Arab Republic

Halla Hannouneh

• Harfoush, Ghaith, Al Andalus University Faculty of Medicine, Tartus, Syrian Arab Republic

Ghaith Harfoush

• Alsaidi, Mhd Aghiad, Syrian Private University Faculty of Medicine, Damascus, Syrian Arab Republic

Mhd Aghiad Alsaidi, MD

• Farah, Ieman, Al Andalus University Faculty of Medicine, Tartus, Syrian Arab Republic

Ieman Farah, DrMed

• Almaalouli, Bsher, North Florida Regional Medical Center Inc, Gainesville, Florida, United States

Bsher Almaalouli, MD

• Alhalabi, Alaa, HCA Florida Orange Park Hospital, Orange Park, Florida, United States

Alaa Alhalabi, MD

• Atta, Mohamed G., Johns Hopkins University, Baltimore, Maryland, United States

Mohamed G. Atta, MD, MPH, FASN

• Hanouneh, Mohamad, Johns Hopkins University, Baltimore, Maryland, United States

Mohamad Hanouneh, MD

• Cervantes, C. Elena, Johns Hopkins University, Baltimore, Maryland, United States

C. Elena Cervantes, MD

Background

Immune checkpoint inhibitors (ICI) have transformed oncologic care but are associated with immune-related adverse events. Electrolyte disturbances (ED) represent an underexplored complication of ICI therapy with limited data across ICI classes.

Methods

We conducted a systematic review and meta-analysis of randomized controlled trials identified on PubMed through January 2024. Studies reporting EDs (Na, K, Ca, Mg, PO4) per CTCAE in patients receiving ICI monotherapy or combination therapy (anti–PD-1/PD-L1 and anti–CTLA-4) were included. Pooled incidences with 95% CIs were calculated using restricted maximum likelihood random-effects models. Odd ratios of individual EDs across ICI classes, with anti–CTLA-4 as reference, were derived via meta-regression when anti–CTLA-4 outcome data were sufficient.

Results

A total of 101 studies (133 cohorts, 15,625 patients) were included. Hyponatremia was most reported among anti–PD-1 (2.64% [1.80–3.85]) and combination regimens (6.95% [3.95–11.94]), hypocalcemia among anti–PD-L1 (5.46% [1.53–17.65]), and hypokalemia among anti–CTLA-4 (4.96% [2.73–8.85]) [Figure 1]. Anti–CTLA-4 data were limited to hyponatremia and hypokalemia due to insufficient reporting. Combination therapy and anti–PD-L1 showed higher incidence of hyponatremia vs anti–CTLA-4 (OR 7.95 [1.73–36.60] p=0.008 and OR 6.81 [1.44–32.23] p=0.016), respectively [Figure 2]. Incidence of hypokalemia was comparable accross ICI classes. Heterogeneity was substantial across all EDs (I² = 46–89%).

Conclusion

Hyponatremia is the most reported ED among ICI-treated patients, with greater incidence in combination and anti–PD-L1 regimens compared to anti–CTLA-4. These findings comprehensively characterize ICI-associated EDs and may inform monitoring practices.