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Practice patterns and outcomes in cancer patients developing immune checkpoint inhibitors-related AKI

Phillip Blanchette1,2,3, Jennifer Reid1, Lucie Richard1,4

  • 1ICES Western, London Health Sciences Centre Research Institute, London Health Sciences Centre, London, Ontario, Canada.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|September 27, 2025
PubMed
Abstract

Insights

Immune checkpoint inhibitor (ICI) therapy for cancer has a modest risk of acute kidney injury (AKI), which is lower than other systemic therapies. Re-challenging patients with ICI after AKI is uncommon but may benefit select individuals.

Area of Science:

  • Oncology
  • Nephrology
  • Immunology

Background:

  • Immune checkpoint inhibitors (ICIs) are crucial in cancer therapy but can cause immune-related adverse events, including acute kidney injury (AKI).
  • Real-world data on AKI incidence, risk factors, and management following ICI therapy are limited.

Purpose of the Study:

  • To determine the incidence, risk factors, and outcomes of AKI in advanced cancer patients undergoing ICI therapy.
  • To compare AKI risk between ICI and non-ICI systemic therapies.
  • To evaluate the safety and outcomes of ICI re-challenge after AKI.

Main Methods:

  • A population-based cohort study in Ontario, Canada (2012-2018) involving 16,425 advanced cancer patients.
  • AKI defined by serum creatinine increase and graded by severity; time-to-event modeling used for risk and survival analysis.
  • Comparison between patients receiving ICI and non-ICI systemic therapy.

Main Results:

  • The 4-year cumulative incidence of any AKI was 29% and severe AKI was 7% among 4,380 patients on ICI therapy.
  • Risk factors for AKI included male sex, genitourinary malignancy, hypertension, diabetes, CKD, and NSAID use.
  • ICI therapy was associated with a significantly lower risk of AKI compared to non-ICI therapy (aHR=0.80).
  • Among patients who stopped ICI due to AKI, 9% were re-challenged, with 44% experiencing recurrent AKI.
  • ICI re-challenge was associated with improved overall survival (aHR=0.38).

Conclusions:

  • Cancer patients receiving ICI therapy have a modest risk of AKI, lower than with other systemic therapies.
  • Re-challenge with ICI after AKI is infrequent but may be considered for select patients.
  • Further research into optimal AKI management and ICI re-challenge strategies is warranted.
Keywords:
acute kidney injurycancerimmune checkpoint inhibitor

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