Acute kidney injury in patients treated with immune checkpoint inhibitors Journal Article
| Authors: | Gupta, S.; Short, S. A. P.; Sise, M. E.; Prosek, J. M.; Madhavan, S. M.; Soler, M. J.; Ostermann, M.; Herrmann, S. M.; Abudayyeh, A.; Anand, S.; Glezerman, I.; Motwani, S. S.; Murakami, N.; Wanchoo, R.; Ortiz-Melo, D. I.; Rashidi, A.; Sprangers, B.; Aggarwal, V.; Malik, A. B.; Loew, S.; Carlos, C. A.; Chang, W. T.; Beckerman, P.; Mithani, Z.; Shah, C. V.; Renaghan, A. D.; Seigneux, S. D.; Campedel, L.; Kitchlu, A.; Sanghoon Shin, D.; Rangarajan, S.; Deshpande, P.; Coppock, G.; Eijgelsheim, M.; Seethapathy, H.; Lee, M. D.; Strohbehn, I. A.; Owen, D. H.; Husain, M.; Garcia-Carro, C.; Bermejo, S.; Lumlertgul, N.; Seylanova, N.; Flanders, L.; Isik, B.; Mamlouk, O.; Lin, J. S.; Garcia, P.; Kaghazchi, A.; Khanin, Y.; Kansal, S. K.; Wauters, E.; Chandra, S.; Schmidt-Ott, K. M.; Hsu, R. K.; Tio, M. C.; Sarvode Mothi, S.; Singh, H.; Schrag, D.; Jhaveri, K. D.; Reynolds, K. L.; Cortazar, F. B.; Leaf, D. E.; ICPi-AKI Consortium Investigators |
| Article Title: | Acute kidney injury in patients treated with immune checkpoint inhibitors |
| Abstract: | Background Immune checkpoint inhibitor-associated acute kidney injury (ICPi-AKI) has emerged as an important toxicity among patients with cancer. Methods We collected data on 429 patients with ICPi-AKI and 429 control patients who received ICPis contemporaneously but who did not develop ICPi-AKI from 30 sites in 10 countries. Multivariable logistic regression was used to identify predictors of ICPi-AKI and its recovery. A multivariable Cox model was used to estimate the effect of ICPi rechallenge versus no rechallenge on survival following ICPi-AKI. Results ICPi-AKI occurred at a median of 16 weeks (IQR 8-32) following ICPi initiation. Lower baseline estimated glomerular filtration rate, proton pump inhibitor (PPI) use, and extrarenal immune-related adverse events (irAEs) were each associated with a higher risk of ICPi-AKI. Acute tubulointerstitial nephritis was the most common lesion on kidney biopsy (125/151 biopsied patients [82.7%]). Renal recovery occurred in 276 patients (64.3%) at a median of 7 weeks (IQR 3-10) following ICPi-AKI. Treatment with corticosteroids within 14 days following ICPi-AKI diagnosis was associated with higher odds of renal recovery (adjusted OR 2.64; 95% CI 1.58 to 4.41). Among patients treated with corticosteroids, early initiation of corticosteroids (within 3 days of ICPi-AKI) was associated with a higher odds of renal recovery compared with later initiation (more than 3 days following ICPi-AKI) (adjusted OR 2.09; 95% CI 1.16 to 3.79). Of 121 patients rechallenged, 20 (16.5%) developed recurrent ICPi-AKI. There was no difference in survival among patients rechallenged versus those not rechallenged following ICPi-AKI. Conclusions Patients who developed ICPi-AKI were more likely to have impaired renal function at baseline, use a PPI, and have extrarenal irAEs. Two-thirds of patients had renal recovery following ICPi-AKI. Treatment with corticosteroids was associated with improved renal recovery. © |
| Keywords: | immunotherapy; ctla-4 antigen; programmed cell death 1 receptor |
| Journal Title: | Journal for ImmunoTherapy of Cancer |
| Volume: | 9 |
| Issue: | 10 |
| ISSN: | 2051-1426 |
| Publisher: | Biomed Central Ltd |
| Date Published: | 2021-10-01 |
| Start Page: | e003467 |
| Language: | English |
| DOI: | 10.1136/jitc-2021-003467 |
| PROVIDER: | scopus |
| PUBMED: | 34625513 |
| PMCID: | PMC8496384 |
| DOI/URL: | |
| Notes: | Article -- Erratum issued, see DOI: 10.1136/jitc-2021-003467corr1 -- Export Date: 2 November 2021 -- Source: Scopus |
