Lower baseline kidney function, use of proton pump inhibitors (PPIs), and extrarenal immune-related adverse events are independent risk factors for acute kidney injury associated with immune checkpoint inhibitor (ICPi-AKI) therapy, according to study data presented at the American Society of Nephrology’s Kidney Week 2021.
The study included 429 patients diagnosed with ICPi-AKI at 30 sites across North America, Europe, and Asia. ICPi-AKI developed at a median of 16 weeks after ICPi initiation. Investigators compared these patients with 429 control patients who received ICPi therapy contemporaneously but did not experience ICPi-AKI.
Compared with a baseline estimated glomerular filtration rate (eGFR, in mL/min/1.73 m2) of 90 or higher, values of 45-59 and less than 45 were significantly associated with 2.2- and 2.6-fold increased odds of ICPi-AKI, respectively, in adjusted analyses, first author Shruti Gupta, MD, MPH, of Brigham and Women’s Hospital in Boston, Massachusetts, reported in an oral presentation. PPI use was significantly associated with 2.4-fold increased odds of ICPi-AKI compared with nonuse. Prior or concomitant extrarenal immune-related adverse events were significantly associated with 2.1-fold increased odds of ICPi-associated AKI.
Renal recovery, defined as a nadir serum creatinine level less than or equal to 1.5 times the baseline value within 90 days following ICPi-AKI, occurred in 276 (64.3%) patients. Treatment with corticosteroids was significantly associated with 2.6-fold increased odds of renal recovery, Dr Gupta reported. Among patients treated with corticosteroids, treatment within 3 days of ICPi-AKI was significantly associated with 2-fold higher odds of renal recovery compared with later treatment.
She noted that 28.2% of patients were rechallenged with an ICPi after an episode of ICPi-AKI. Of these, recurrent ICPi-AKI developed in only 16.5% of them, “which shows that rechallenge should be considered in these patients,” she said.
Gupta S, Leaf DE. AKI in patients treated with immune checkpoint inhibitors. Presented at: Kidney Week 2021, November 2-7, 2021. Abstract TH-OR02.