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Immune checkpoints inhibitors and its link to acute kidney injury and renal prognosis

  • Nephrology - Original Paper
  • Published:
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Abstract

Background

Immunotherapy with immune checkpoint inhibitors (ICPi) may cause acute kidney injury (AKI) and their use is increasing.

Materials and methods

This is a single-center retrospective cohort study of patients receiving ICPi drugs for solid organ malignancies. ICPi-related AKI, the need for renal replacement therapy during or following ICPi treatment, and the associated mortality was studied.

Results

Two hundred thirty five patients were included in the final analysis. Patients with (N = 40) and without (n = 195) AKI had similar age, sex, type of ICPi, baseline serum creatinine levels, comorbidities and mortality; while patients with AKI were more likely to be receiving a nephrotoxic agent or be treated for genitourinary malignancy. 18 patients had ICPi-related AKI; 7 of these patients underwent kidney biopsy, which showed acute interstitial nephritis while the remaining 11 were diagnosed on clinical parameters. 18 (45%) patients recovered kidney function after AKI. No differences were observed between patients with and without kidney function recovery, although patients without recovery had a numerical, but not statistically significant, higher mortality. Patients with biopsy-confirmed ICPi-induced AKI had an increased risk of mortality, as compared with the rest of the population—HR 1.83, 95% CI 1.22–2.74, p = 0.003.

Conclusion

Use of nephrotoxic drugs and the location of malignancy appear to be common drivers of AKI in patients receiving ICPis for solid organ malignancy. Whether nephrotoxic agents or urinary tract obstruction may favor ICPi-related autoimmunity should be further studied.

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Acknowledgements

MK gratefully acknowledge use of the services and facilities of the Koc University Research Center for Translational Medicine (KUTTAM), funded by the Presidency of Turkey, Presidency of Strategy and Budget. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Presidency of Strategy and Budget.

Funding

This study was not funded by any grant.

Author information

Authors and Affiliations

  1. Department of Medicine, Section of Nephrology, Koc University School of Medicine, 34010, Istanbul, Turkey

    Mehmet Kanbay & Nuri Baris Hasbal

  2. Department of Medicine, Koc University School of Medicine, Istanbul, Turkey

    Abdullah Burak Yildiz, Sezan Vehbi, Yavuz E. Kesgin, Melisa Celayir & Fatih Selcukbiricik

  3. Department of Nephrology, “Saint John the New” County Hospital, Suceava, Romania

    Dimitrie Siriopol

  4. Stefan Cel Mare” University, Suceava, Romania

    Dimitrie Siriopol

  5. Department of Nephrology, Grigore T. Popa’ University of Medicine, Iasi, Romania

    Adrian Covic

  6. Department of Internal Medicine Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA

    Mark A. Perazella

Authors
  1. Mehmet Kanbay
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  2. Abdullah Burak Yildiz
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  3. Dimitrie Siriopol
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  4. Sezan Vehbi
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  5. Nuri Baris Hasbal
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  6. Yavuz E. Kesgin
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  7. Melisa Celayir
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  8. Fatih Selcukbiricik
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  10. Mark A. Perazella
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Contributions

Contributed substantially to the conception or design of the work: MK, ABY, FS. Contributed substantially to acquisition, analysis, or interpretation of data: ABY, MK, FS, NBH, SV, MC, YEK, DS. Drafted the manuscript: ABY, SV, DS. Revision of the manuscript for important intellectual content: MK, ABY, FS, DS, MP.

Corresponding author

Correspondence to Mehmet Kanbay.

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All authors declare that they have no conflict of interest.

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This study was approved by the Institutional Review Board of Koc University School of Medicine.

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Kanbay, M., Yildiz, A.B., Siriopol, D. et al. Immune checkpoints inhibitors and its link to acute kidney injury and renal prognosis. Int Urol Nephrol 55, 1025–1032 (2023). https://doi.org/10.1007/s11255-022-03395-y

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  • DOI: https://doi.org/10.1007/s11255-022-03395-y

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