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Immune-related adverse events and kidney function decline in patients with genitourinary cancers treated with immune

Harish Seethapathy1, Sarah Street1, Ian Strohbehn1

  • 1Department of Internal Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, MA, USA.

European Journal of Cancer (Oxford, England : 1990)
|September 5, 2021
PubMed
Abstract

Insights

Immune checkpoint inhibitors (ICIs) can cause acute kidney injury (AKI) and sustained kidney function loss in genitourinary cancer patients. Immune-related adverse events (irAEs) may increase the risk of kidney decline in patients on ICIs.

Area of Science:

  • Nephrology
  • Oncology
  • Immunology

Background:

  • The impact of immune checkpoint inhibitors (ICIs) on kidney function in genitourinary cancer patients remains unclear.
  • Genitourinary cancers include renal cell carcinoma (RCC) and urothelial carcinoma.

Purpose of the Study:

  • To investigate the incidence and predictors of acute kidney injury (AKI) and sustained estimated glomerular filtration rate (eGFR) loss in genitourinary cancer patients treated with ICIs.
  • To assess the association between immune-related adverse events (irAEs) and adverse kidney outcomes in these patients.

Main Methods:

  • Retrospective cohort study of 637 patients with RCC or urothelial carcinoma treated with ICIs between 2012 and 2018.
  • Utilized cumulative incidence and Fine and Gray subdistribution hazard models to identify predictors of AKI and sustained eGFR loss (>20% decline for ≥90 days).
  • Examined the relationship between irAEs and kidney outcomes in patients surviving ≥1 year.

Main Results:

  • AKI and sustained eGFR loss occurred in 25% and 16% of patients, respectively. Immune-related adverse events (irAEs) were observed in 33% of patients.
  • Patients with RCC had a higher likelihood of developing irAEs and sustained eGFR loss compared to urothelial carcinoma patients.
  • Non-renal irAEs were associated with a significantly increased risk of sustained eGFR loss in patients surviving ≥1 year.

Conclusions:

  • Acute kidney injury and sustained eGFR loss are frequent complications in genitourinary cancer patients receiving ICIs.
  • Immune-related adverse events may represent a novel risk factor for kidney function deterioration in patients undergoing ICI therapy.
Keywords:
Acute kidney injuryChronic kidney diseaseImmune checkpoint inhibitor

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