Acute kidney injury with immune checkpoint inhibitors

Abstract

Monitoring of renal function and early identification of acute kidney injury (AKI) is essential during treatment with immune checkpoint inhibitors (CPIs), according to study results reported in the European Journal of Cancer, even though the incidence of AKI is relatively low. The retrospective study* investigated the AKI incidence in 352 consecutive patients, ≥18 years of age, who underwent CPI treatment at Hôpital Lyon Sud between January 2015 and July 2017. The median patient age was 67 years; 223 patients were men. AKI occurred in 13 patients (3.7%), after 35–480 (median 148) days of treatment. AKI developed in two patients exposed for ≤3 months, which was a significantly different risk compared with longer exposure; the authors note that this suggests an exposure-time-dependent risk . All cases occurred in patients who received anti-PD-1 agents, either nivolumab (n=9) or pembrolizumab (n=4). No cases occurred in patients who received anti-CTLA-4 or anti-PD-L1 agents, although the authors note that this is probably due to a lack of statistical power in the present study . AKI severity was stage 1 (n=6), 2 (n=5) or 3 (n=3). Although patients with CPI-induced AKI had a higher incidence of extrarenal immune-related adverse events than other patients (77% vs 39%), the risk of AKI was not significantly higher in such patients. The AKI risk was not increased in patients with pre-existing chronic kidney disease. However, fluindione recipients did have a significantly higher risk of AKI. CPI treatment was withdrawn in all patients who developed AKI. Seven patients received systemic corticosteroid therapy. Of the five patients who reintroduced treatment with the same CPI, AKI recurred in one nivolumab recipient. The optimal management of CPI-induced AKI remains unclear , conclude the authors, and requires a close collaboration between the oncology and nephrology departments .