Highlights
- •Checkpoint inhibitor (CPI)-induced acute kidney injury (AKI) is a rare life-threatening immune-related adverse event (IRAE).
- •We described CPI-induced AKI incidence at 3.7% (n = 13/352) in a large real-life cohort.
- •No patients had evidence of glomerular injury (only acute tubulointerstitial nephritis [ATIN]).
- •CPI-induced AKIs were often associated with other IRAEs.
Abstract
Background/objectives
Acute Kidney Injury (AKI), induced by Checkpoint Inhibitors therapies (CPI-induced
AKI), is an uncommon but severe Immune-Related Adverse Event (IRAE). The aim was to
describe the epidemiology, risks factors, clinical, and laboratory characteristics
of these renal adverse events (AEs) in a real-life cohort treatment.
Design/participants
Consecutive patients undergoing a checkpoint inhibitor (CPI) therapy at the Hôpital Lyon Sud from January 2015 to July 2017 were included. A systematic retrospective analysis
of medical files was performed, monthly serum creatinine levels, associated treatments,
and occurrence of other IRAEs data were collected. AKI episodes explained by classic
AKI aetiologies (prerenal, obstructive, septic) were excluded from the analysis.
Results
CPI-induced AKI incidence was 3.7% (13/352) and appeared to be time-dependent (7.7%
(11/143) for patients with >3 months of CPI exposure), ranging from 1 to 16 months.
All cases with available histology were acute tubulointerstitial nephritis (ATIN),
with poor urinary sediment. The severity of AKI was mild (stage 1 in 50% of cases),
with no need for renal-replacement therapy. Although CPI-induced AKI patients had
more frequently other IRAEs (77% versus 39%), this was not associated with a greater
risk of AKI. Pre-existing chronic kidney disease (defined as an estimated glomerular
filtration rate (eGFR) <60 ml/min) was not associated with a greater risk of CPI-induced
AKI. Treatments of CPI-induced AKI were heterogeneous, with discontinuation of CPIs,
and inconstant systemic corticosteroid therapy.
Conclusion
The monitoring of renal function and early identification of AKI during CPIs treatment
is essential. The optimal management of CPI-induced AKI remains unclear and requires
a close collaboration between the oncology and nephrology departments.
Clinical relevancy statement
Immune checkpoint inhibitors (CPIs) have dramatically improved patient outcomes in
different malignant contexts such as melanoma, non-small cell lung cancers (NSCLC) and
urologic cancers. Usually well-tolerated, CPIs are however associated with immune-related
adverse events (IRAEs). Among them, acute kidney injury (AKI) is uncommon, and not
well-described. Following the exponential increase in the prescription of CPIs, previously
uncommon cases of IRAEs (such as AKI) have become common occurrence in referral centres.
Data regarding the epidemiology, risk factors, or management of CPI-induced AKI are
currently lacking or can be discordant. Data regarding CPI-induced AKI, in a large
real-life cohort were reported herein.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: February 16, 2021
Accepted:
January 12,
2021
Received in revised form:
January 8,
2021
Received:
October 8,
2020
Identification
Copyright
© 2021 Elsevier Ltd. All rights reserved.
