Acute Kidney Injury in Recipients of Chimeric Antigen Receptor T-Cell therapy: Clinical Characteristics and Impact on...

Chimeric antigen receptor T-cell (CAR-T) therapy is a breakthrough in hematologic malignancies but carries risks, including acute kidney injury (AKI). AKI may arise due to inflammatory responses like cytokine release syndrome (CRS), which affects renal perfusion. This study is intended to report on the incidence and characteristics of AKI and potential associated factors in patients receiving CAR-T therapy. This retrospective study analyzed 186 patients treated with CAR-T therapy, assessing AKI incidence, timing, severity, and associated risk factors within 100 days postinfusion of CAR-T product. AKI was defined by KDIGO criteria. CRS was graded based on the criteria of the American Society of Transplantation and Cellular Therapy. Among 186 patients (103 with multiple myeloma (MM), 75 with non-Hodgkin Lymphoma (NHL), and 8 with leukemia), 34% developed AKI (95% CI: 27% to 40.7%) with similar incidence by cancer type. Most cases (77.8%) occurred within three weeks of postinfusion. AKI was more common among African American individuals (57.7%, P = .015) and with older age (median 67 versus 62 years, P = .003). Patients with CKD were more likely to have AKI (50.8% versus 25.6%, P < .001). Overall CRS incidence was 82.8% (95% CI: 76.7% to 87.5%) , and 35.1% had AKI although no statistical significance found when compared to those without CRS. Higher grades of CRS had higher incidence of AKI (Grade 1 = 33.9%; Grade 2 = 37.9%, Grade 3 = 42.9%, P = .83) Most AKI episodes were Grade 1 (69.8%) and reversible; 71.4% recovered baseline kidney function, while 28.6% did not, two died within 100 days, 1 required dialysis. AKI postinfusion was common among patients with prior AKI (50.8%) (P < .001). AKI was associated 2.6 times higher odds of death compared to those without AKI (OR 2.57, P = .019). After adjusting for age, sex, CRS, ICANS, and malignancy type, AKI was independently associated with increased mortality (adjusted HR: 2.59, 95% CI: 1.33 to 5.04). AKI is a frequent and early complication of CAR-T therapy, particularly among African American patients, older individuals, those with CKD and prior history of AKI. While most cases are mild and reversible, identifying high-risk patients may enhance monitoring, supportive care, and early intervention.