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Published on: April 12, 2017

Efficacy of checkpoint inhibitors in genitourinary cancers with advanced chronic kidney disease

Yin-Shen Chen1,2,3,4, Chia-Cheng Yu5, Renin Chang6,7

  • 1Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1 Rd., Kaohsiung City, 813414, Taiwan. tmcdodo@gmail.com.

Cancer Immunology, Immunotherapy : CII
|July 9, 2026
PubMed
Abstract

Insights

Immunological checkpoint inhibitors (ICIs) show promise for genitourinary cancers, but patients with advanced chronic kidney disease (aCKD) face worse survival and higher risks of acute kidney injury (AKI) when treated with ICIs.

Area of Science:

  • Oncology
  • Nephrology
  • Immunology

Background:

  • Immunological checkpoint inhibitors (ICIs) are effective cancer treatments but their use in genitourinary cancers among patients with advanced chronic kidney disease (aCKD) is understudied.
  • Patients with advanced chronic kidney disease (aCKD) are often excluded from clinical trials, limiting understanding of ICI efficacy and safety in this population.

Purpose of the Study:

  • To evaluate the efficacy and safety of immunological checkpoint inhibitors (ICIs) in patients with genitourinary cancers and advanced chronic kidney disease (aCKD).

Main Methods:

  • Retrospective cohort study using the TriNetX US Collaborative Network database (January 2015–December 2023).
  • Included patients with renal cell carcinoma and urothelial carcinoma diagnosed with advanced chronic kidney disease (aCKD) or early chronic kidney disease (eCKD).
  • Compared outcomes after 1:1 propensity score matching, assessing all-cause mortality and immune-related adverse events (irAEs).

Main Results:

  • The study included 2213 patients with aCKD and 9784 with eCKD receiving ICIs; 2196 patients remained in each cohort post-matching.
  • Patients with aCKD exhibited higher 2-year all-cause mortality (44.7% vs. 35.5%) and a modestly higher risk of overall coded irAEs (HR=1.141).
  • Acute kidney injury (AKI) was a significant driver of irAEs in the aCKD cohort (HR=1.662), with increased risks of mortality and AKI persisting up to 60 months.

Conclusions:

  • Advanced chronic kidney disease (aCKD) is associated with worse survival and increased renal vulnerability in patients with genitourinary cancers treated with ICIs.
  • CKD should not automatically preclude ICI use in carefully selected patients.
  • Close renal monitoring and multidisciplinary management are crucial for patients with aCKD receiving ICIs, especially those with advanced disease.
Keywords:
Chronic kidney diseaseGenitourinary cancersImmunological checkpoint inhibitors

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