Incidence and risk factors of acute kidney injury, and its effect on mortality among Japanese patients receiving immune check point inhibitors: a single-center observational study

• Published in: Clinical and experimental nephrology Vol. 25; no. 5; pp. 479 - 487
• Main Authors: Shimamura, Yoshinosuke, Watanabe, Shota, Maeda, Takuto, Abe, Koki, Ogawa, Yayoi, Takizawa, Hideki
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.05.2021; Springer Nature B.V
• Subjects: Creatinine; Immune checkpoint inhibitors; Immunotherapy; Kidneys; Liver diseases; Medicine; Medicine & Public Health; Monoclonal antibodies; Mortality; Nephrology; Observational studies; Original Article; Pembrolizumab; Regression analysis; Risk factors; Urology; Pembrolizumab; Immune checkpoint inhibitor; Acute kidney injury; Mortality; Liver disease
• ISSN: 1342-1751; 1437-7799
• DOI: 10.1007/s10157-020-02008-1

Background Immune checkpoint inhibitors (ICPis) are associated with multi-organ immune-related adverse effects. Here, we examined the incidence rate, recovery rate, and risk factors of acute kidney injury complicated with ICPis (ICPi-AKI) and evaluted the association between ICPi-AKI and mortality in Japanese patients. Methods We analyzed 152 consecutive patients receiving ICPis between 2015 and 2019. A logistic regression analysis was performed to identify risk factors for ICPi-AKI incidence and Cox regression analysis was performed to evaluate the association between ICPi-AKI and mortality. Results The mean patient age was 67 ± 10 years, with the median baseline serum creatinine level of 0.78 mg/dL. Twenty-seven patients (18%) developed ICPi-AKI, and 19 (73%) of them recovered. Pembrolizumab use and liver diseases were significant risk factors for the ICPi-AKI incidence. During the follow-up, 85 patients (59%) died, 17 patients (63%) with ICPi-AKI and 68 (54%) patients without ICPi-AKI, respectively. The ICPi-AKI incidence was not independently associated with mortality (adjusted hazard ratio, 0.85; 95% confidence intervals, 0.46–1.61). Conclusions Our finding suggest that pembrolizumab use and liver diseases are associated with a higher risk of ICPi-AKI development, but ICPi-AKI did not affect mortality. Future multi-center studies are needed to develop optimal management and prevention strategies for this complication in patients receiving ICPis.