Kidney Week

Abstract: SA-PO1257

Immune Checkpoint Inhibitors and AKI in Patients with Cancer and COVID-19

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

• Cho, Yoon Jung, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Yoon Jung Cho, MD

• Jo, Jeongjae, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Jeongjae Jo, MD

• Jang, Yoonjoo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Yoonjoo Jang, MD

• Gu, Juyeon, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Juyeon Gu, MD

• Jeon, Junseok, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Junseok Jeon, MD, PhD

• Jang, Hye Ryoun, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Hye Ryoun Jang, MD, PhD

• Lee, Jung eun, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Jung eun Lee, MD, PhD

• Huh, Wooseong, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Wooseong Huh, MD, PhD

• Lee, Kyungho, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)

Kyungho Lee, MD, PhD

Background

COVID-19 induces AKI primarily through immune-mediated mechanisms, including cytokine-driven inflammation. Cancer patients face an elevated risk of both severe COVID-19 and kidney complications. Immune checkpoint inhibitors (ICIs) can themselves cause immune-related kidney injury. How ICI therapy alters AKI risk in cancer patients with COVID-19 remains unclear. We aimed to evaluate the association between ICI exposure and AKI incidence in cancer patients with COVID-19.

Methods

Cancer patients with COVID-19 confirmed by SARS-CoV-2 PCR between 2020 and 2023 were identified at a tertiary academic hospital in South Korea. AKI was defined and staged according to KDIGO criteria. Propensity score matching (1:3 ratio) based on age, sex, cancer type, comorbidities, and baseline eGFR was performed to compare AKI incidence and severity between ICI-treated and non-ICI-treated patients. Adjusted odds ratios (aORs) were derived from multivariable logistic regression, and 90-day overall survival was compared between the matched groups.

Results

Among 910 cancer patients with COVID-19, 87 (9.6%) had received ICI prior to infection. Before matching, AKI incidence was lower in the ICI-treated group compared to the non-ICI-treated group (13.8% vs. 23.9%, P=0.034). After 1:3 matching to 261 patients without ICI exposure, AKI occurred in 13.8% of ICI-treated patients compared to 31.0% of non-ICI-treated patients (P=0.002). Stage 3 AKI was also less frequent in the ICI-treated group (0% vs. 6.9%). After adjustment for patient demographics, comorbidities, eGFR, hemoglobin, serum albumin, serum sodium, CRP, and LDH, multivariable logistic regression identified ICI treatment as an independent predictor of reduced AKI risk (aOR 0.37, 95% CI 0.19–0.75). Subgroup analyses revealed that the ICI monotherapy group had the lowest AKI incidence (5.3%), followed by ICI plus chemotherapy (21.1%), no anticancer treatment (23.7%), and chemotherapy alone (26.3%). No significant difference in 90-day overall survival was observed between the matched groups.

Conclusion

In cancer patients with COVID-19, ICI exposure was associated with a significantly lower risk of AKI compared to other treatment modalities, with ICI monotherapy showing the most pronounced effect. These findings suggest that ICI exposure does not increase—and may even reduce—kidney risk in this population, supporting its continued use during COVID-19.