학술논문
Acute kidney injury in patients treated with immune checkpoint inhibitors
Document Type
article
Author
Joe-Elie Salem; Enriqueta Felip; Sophie Papa; Shuchi Anand; Karolina Benesova; Marlies Ostermann; Ala Abudayyeh; Omar Mamlouk; Umut Selamet; Grace Cherry; Sunandana Chandra; Sandra M Herrmann; Maria Jose Soler; Abhijat Kitchlu; Jamie S Lin; Kerry L Reynolds; Osama E Rahma; Elizabeth M Gaughan; Eva Muñoz-Couselo; Jamie S Hirsch; Pablo Garcia; Meghan D Lee; Harish Seethapathy; Ian A Strohbehn; Meghan E Sise; Wei-Ting Chang; Els Wauters; Lucy Flanders; Deborah Schrag; Thibaud Koessler; Mark Eijgelsheim; Shruti Gupta; Frank B Cortazar; Samuel A P Short; Jason M Prosek; Sethu M Madhavan; Ilya Glezerman; Shveta S Motwani; Naoka Murakami; Rimda Wanchoo; David I Ortiz-Melo; Arash Rashidi; Ben Sprangers; Vikram Aggarwal; A Bilal Malik; Sebastian Loew; Christopher A Carlos; Pazit Beckerman; Zain Mithani; Chintan V Shah; Amanda D Renaghan; Sophie De Seigneux; Luca Campedel; Daniel Sanghoon Shin; Sunil Rangarajan; Priya Deshpande; Gaia Coppock; Dwight H. Owen; Marium Husain; Clara Garcia-Carro; Sheila Bermejo; Nuttha Lumlertgul; Nina Seylanova; Busra Isik; Aydin Kaghazchi; Yuriy Khanin; Sheru K Kansal; Kai M Schmidt-Ott; Raymond K Hsu; Maria C Tio; Suraj Sarvode Mothi; Harkarandeep Singh; Kenar D Jhaveri; David E Leaf; Corinne Isnard Bagnis; Suraj S Mothi; Weiting Chang; Vipulbhai Sakhiya; Daniel Stalbow; Sylvia Wu; Armando Cennamo; Anne Rigg; Nisha Shaunak; Zoe A Kibbelaar; Harish S Seethapathy; Meghan Lee; Ian A Strohbhen; Ilya G Glezerman; Dwight H Owen; Sharon Mini; Andrey Kisel; Nicole Albert; Katherine Carter; Vicki Donley; Tricia Young; Heather Cigoi; Els Wauters Ben Sprangers; Javier A Pagan; Jonathan J Hogan; Valda Page; Samuel AP Short; Maria Josep Carreras
Source
Journal for ImmunoTherapy of Cancer, Vol 9, Iss 10 (2021)
Subject
Language
English
ISSN
2051-1426
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.