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Clinical outcomes after immune checkpoint inhibitor-associated acute kidney injury: a cohort study
Ting-Ya Yang1, Min-Hsiang Chuang2, Hong-Min Lin1
1Department of Family Medicine, Chi Mei Medical Center, Tainan, Taiwan.
Objectives:
Immune checkpoint inhibitors (ICPi) have significantly improved survival for patients with advanced cancers. However, the occurrence of ICPi-associated acute kidney injury (AKI) and its clinical impact remains unclear. This study evaluates the effects of ICPi-associated AKI (ICPi-AKI) on mortality, kidney and cardiovascular outcomes in patients undergoing ICPi treatments.
Design:
This multicentre retrospective cohort study with propensity score matching to balance baseline characteristics. The International Classification of Diseases, 10th Revision codes were used to identify individuals with cancer and treated with ICPi concurrently. Kaplan-Meier analyses coupled with log-rank tests were conducted to estimate the survival probabilities.
Setting:
Data were sourced from the TriNetX database spanning records from 25 March 2011 to 5 April 2024.
Participants:
Patients with cancer aged ≥18 years treated with ICPi with or without AKI occurrence.
Primary And Secondary Outcome Measures:
The primary outcome was all-cause mortality, and secondary outcomes included major adverse kidney events (MAKE), major adverse cardiovascular events (MACE), the composite of MAKE or MACE with death, and end-stage renal disease.
Results:
The study identified 926 patients with cancer who developed ICPi-AKI (mean age, 67.1±11.8 years; 57.4% men). The control group consisted of 48 147 patients treated with ICPi but did not develop AKI (mean age, 65.3±13.1 years; 53.7% men). After matching, the ICPi-AKI group exhibited a higher risk of all-cause mortality (HR=1.27; 95% CI 1.02 to 1.61), MAKE (HR=3.83; 95% CI 1.72 to 8.40), MACE (HR=1.35; 95% CI 1.03 to 1.75)) compared with the non-ICPi-AKI group. Subgroup analyses confirmed these findings across various patient's characteristics.
Conclusion:
Individuals with ICPi-AKI are associated with an increased risk of all-cause mortality, MAKE and MACE. Enhancing awareness and timely intervention for ICPi-AKI are crucial for improving prognosis and reducing complications among patients with cancer.
Insights
Immune checkpoint inhibitor-associated acute kidney injury (ICPi-AKI) significantly increases mortality and adverse kidney and cardiovascular events in cancer patients. Early detection and intervention for ICPi-AKI are vital for improving patient outcomes.
Area of Science:
- Nephrology
- Oncology
- Immunology
Background:
- Immune checkpoint inhibitors (ICPi) have revolutionized advanced cancer treatment, improving patient survival.
- The incidence and clinical impact of acute kidney injury (AKI) associated with ICPi (ICPi-AKI) remain incompletely understood.
- This study investigates the association between ICPi-AKI and patient outcomes.
Purpose of the Study:
- To evaluate the impact of ICPi-AKI on all-cause mortality in cancer patients.
- To assess the effects of ICPi-AKI on major adverse kidney events (MAKE) and major adverse cardiovascular events (MACE).
- To determine the association of ICPi-AKI with end-stage renal disease and composite outcomes.
Main Methods:
- A multicentre retrospective cohort study utilizing the TriNetX database (March 2011–April 2024).
- Propensity score matching was employed to balance baseline characteristics between patients with and without ICPi-AKI.
- Kaplan-Meier analyses and log-rank tests were used to estimate survival probabilities.
Main Results:
- The study included 926 patients with ICPi-AKI and 48,147 controls.
- Patients with ICPi-AKI demonstrated a significantly higher risk of all-cause mortality (HR=1.27), MAKE (HR=3.83), and MACE (HR=1.35) compared to controls.
- Subgroup analyses confirmed these elevated risks across diverse patient characteristics.
Conclusions:
- ICPi-AKI is significantly associated with increased risks of all-cause mortality, MAKE, and MACE.
- Enhanced clinical awareness and prompt management of ICPi-AKI are critical for improving prognosis.
- Timely intervention can mitigate complications and enhance survival for cancer patients receiving ICPi therapy.
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