Kidney Week

Abstract: SA-PO1245

AKI After Chimeric Antigen Receptor-T Cell Therapy: Incidence, Clinical Course, and Kidney Outcomes

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

• Del Castillo Rix, Daniel Sebastian, University of Miami Department of Medicine, Miami, Florida, United States

Daniel Sebastian Del Castillo Rix, MD

• De Alencar Salazar Primo, Guilherme, University of Miami Department of Medicine, Miami, Florida, United States

Guilherme De Alencar Salazar Primo, MD

• Duque, Nicolas, University of Miami Department of Medicine, Miami, Florida, United States

Nicolas Duque, MD

• Dejman, Adriana, University of Miami Department of Medicine, Miami, Florida, United States

Adriana Dejman

• Sosa, Marie Anne, University of Miami Department of Medicine, Miami, Florida, United States

Marie Anne Sosa, MD, MBA

• Duque, Juan, University of Miami Department of Medicine, Miami, Florida, United States

Juan Duque, MD

Background

Chimeric antigen receptor T-cell (CAR-T) therapy may be complicated by acute kidney injury (AKI). The clinical phenotype, trajectory, and kidney outcomes of CAR-T-associated AKI remain incompletely characterized.

Methods

We conducted a retrospective cohort study of adults undergoing CAR-T therapy at a large academic center from 2017–2025. AKI occurring within 7 days of infusion was defined using KDIGO serum creatinine criteria. AKI severity, timing, duration, recovery, and kidney outcomes were evaluated. Kidney function was assessed with serum creatinine and eGFR using the CKD-EPI 2021 equation.

Results

Among 305 patients receiving CAR-T therapy, 43 (14.1%) developed AKI within 7 days of infusion. AKI phenotype and clinical course are summarized in Table 1. Most AKI episodes were mild: KDIGO stage 1 in 35 patients (81.4%), stage 2 in 5 (11.6%), and stage 3 in 3 (7.0%). AKI developed a median of 5 days after infusion (IQR 4–7), with a median peak creatinine of 1.18 mg/dL (IQR 1.00–1.42) and a median creatinine increase of 0.36 mg/dL (IQR 0.34–0.43). AKI duration was brief (median 1 day, IQR 1–2), and kidney recovery by discharge occurred in 37 patients (86.1%).
Despite the transient nature of most episodes, kidney function at discharge differed between groups. Patients with AKI had higher median serum creatinine (0.86 vs 0.74 mg/dL, p=0.027) and lower mean eGFR (86.5 vs 96.0 mL/min/1.73m2, p=0.0098) compared with those without AKI. Baseline CKD prevalence and incident CKD were similar between groups; however, CKD progression occurred more frequently among patients with AKI (62.8% vs 36.6%, p=0.001). Mean serum creatinine trajectories among patients with AKI following CAR-T infusion demonstrated an early rise, subsequent improvement, and mild late increase over the first 90 days.

Conclusion

AKI occurred in approximately one in seven patients following CAR-T therapy and was typically early, mild, and transient. Patients with AKI experienced more frequent CKD progression. Prospective studies are needed to determine whether CAR-T–associated AKI contributes to long-term kidney dysfunction and to identify patients at highest risk for AKI.