Incidence and Outcomes of Renal Adverse Events following Treatment with Immune Checkpoint Inhibitors

Abstract

Aim: To determine the incidence of renal adverse events in patients treated with checkpoint inhibitors (CPI) and the outcomes of renal insufficiency events. To determine the risk factors predisposing patients to renal insufficiency in patients treated with CPI.

Design and methods: A prospective single arm cohort study was designed. All patients aged above 18 with solid organ malignancies starting therapy with CPI from April 2020 were observed at baseline and followed up for a period of one year. Patients with Chronic kidney disease (CKD) 4 and above were excluded. Demographic data, concurrent medical conditions, medications, malignancy type, CPI type were recorded at baseline and during follow up. Two renal physicians determined the aetiology of renal insufficiency as CPI related or unrelated. Univariate logistic regression was performed to identify patient characteristics associated with development of acute kidney injury (AKI). Kaplan-Meier was used to determine survival differences between those who did and did not develop AKI

Results:  The incidence of CPI induced AKI was 2.9%. Multivariate analysis showed proton pump inhibitor (PPI) use to be associated with high risk of CPI induced all-cause AKI. There was a trend towards increased mortality in patients who developed all-cause AKI. However, there was no mortality in patients with CPI induced AKI.

Conclusion: Our single centre study showed that the incidence of renal insufficiency events is minimal in patients treated with CPI. PPI use increased risk of all-cause AKI in these patients. CPI associated AKI is not associated with increased mortality.