The Incidence, Causes, and Risk Factors of Acute Kidney Injury in Patients Receiving Immune Checkpoint Inhibitors

Immune checkpoint inhibitor use in oncology is increasing rapidly. We sought to determine the frequency, severity, cause, and predictors of AKI in a real-world population receiving checkpoint inhibitors. We included all patients who received checkpoint inhibitor therapy from May 2011 to December 201...

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Bibliographic Details
Published in:Clinical journal of the American Society of Nephrology 2019-12, Vol.14 (12), p.1692-1700
Main Authors: Seethapathy, Harish, Zhao, Sophia, Chute, Donald F, Zubiri, Leyre, Oppong, Yaa, Strohbehn, Ian, Cortazar, Frank B, Leaf, David E, Mooradian, Meghan J, Villani, Alexandra-Chloé, Sullivan, Ryan J, Reynolds, Kerry, Sise, Meghan E
Format: Article
Language:English
Subjects:
Acute Kidney Injury - epidemiology
Acute Kidney Injury - etiology
Aged
B7-H1 Antigen - antagonists & inhibitors
Creatinine - blood
CTLA-4 Antigen - antagonists & inhibitors
Glomerular Filtration Rate
Humans
Incidence
Middle Aged
Original
Programmed Cell Death 1 Receptor - antagonists & inhibitors
Proton Pump Inhibitors - adverse effects
Retrospective Studies
Risk Factors
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Summary:Immune checkpoint inhibitor use in oncology is increasing rapidly. We sought to determine the frequency, severity, cause, and predictors of AKI in a real-world population receiving checkpoint inhibitors. We included all patients who received checkpoint inhibitor therapy from May 2011 to December 2016 at Massachusetts General Hospital. Baseline serum creatinine, averaged 6 months before checkpoint inhibitor start date, was compared with all subsequent creatinine values within 12 months of starting therapy. AKI was defined by Kidney Disease: Improving Global Outcomes criteria for fold changes in creatinine from baseline. Sustained AKI events lasted at least 3 days and was our primary outcome. The cause of sustained AKI was determined by chart review. Cumulative incidence and subdistribution hazard models were used to assess the relationship between baseline demographics, comorbidities, and medications, and sustained AKI and potential checkpoint inhibitor-related AKI. We included 1016 patients in the analysis. Average age was 63 (SD 13) years, 61% were men, and 91% were white. Mean baseline creatinine was 0.9 mg/dl (SD 0.4 mg/dl), and 169 (17%) had CKD (eGFR
ISSN:1555-9041
1555-905X
DOI:10.2215/CJN.00990119