Open AccessIncidence and Prediction of Immune Checkpoint Inhibitor-related Nephrotoxicity
Author(s) -
Jonathan D Sorah,
Tracy L. Rose,
Roshni Radhakrishna,
Vimal K. Derebail,
Matthew I. Milowsky
Publication year - 2020
Publication title -
journal of immunotherapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.805
H-Index - 92
eISSN - 1537-4513
pISSN - 1524-9557
DOI - 10.1097/cji.0000000000000338
Subject(s) - medicine , incidence (geometry) , acute kidney injury , renal function , adverse effect , creatinine , nephrotoxicity , kidney disease , dialysis , urinalysis , urinary system , kidney , physics , optics
Immune checkpoint inhibitors (ICIs) may cause immune-related adverse events that can affect any organ system, including the kidneys. Our study aimed to better characterize the incidence of and predictive factors for immune-related acute kidney injury (irAKI) and evaluate steroid responsiveness. An institutional database (Carolina Data Warehouse) was queried for patients who received ICIs and subsequently had substantial AKI, defined as a doubling of baseline creatinine. A retrospective chart review was performed to determine the cause of AKI. AKI events determined to be immune-related were further analyzed. A total of 1766 patients received an ICI between April 2014 and December 2018. A total of 123 (7%) patients had an AKI within 1 year of the administration of the first ICI dose. 14 (0.8% of all patients who received ICIs) of the AKI events were immune-related. History of an autoimmune disease (N=2, 14%, P=0.04) or history of other immune-related adverse events (irAEs) (N=8, 57%, P=0.01) was a significant predictor of irAKI. Of 14 irAKI patients, 9 received steroids with renal function improving to baseline in 5 patients, improving but not to baseline in 2, and 2 without improvement in renal function, including 1 becoming dialysis-dependent. Age, sex, urinalysis findings, and primary tumor site were not associated with irAKI. irAKI is relatively uncommon but likely under-recognized. Underlying autoimmune disease and history of nonrenal ICI-related irAEs are associated with irAKI. Early recognition and steroid administration are important for a positive outcome.