1. Acute kidney injury in patients treated with immune checkpoint inhibitors
- Author
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Enriqueta Felip, Sophie Papa, Shuchi Anand, Karolina Benesova, Ala Abudayyeh, Omar Mamlouk, Umut Selamet, Grace Cherry, Sunandana Chandra, Sandra M Herrmann, Maria Jose Soler, Abhijat Kitchlu, Jamie S Lin, Kerry L Reynolds, Osama E Rahma, Elizabeth M Gaughan, Eva Muñoz-Couselo, Jamie S Hirsch, Pablo Garcia, Meghan D Lee, Harish Seethapathy, Ian A Strohbehn, Meghan E Sise, Wei-Ting Chang, Els Wauters, Lucy Flanders, Deborah Schrag, Thibaud Koessler, Mark Eijgelsheim, Shruti Gupta, Frank B Cortazar, Samuel A P Short, Jason M Prosek, Sethu M Madhavan, Ilya Glezerman, Shveta S Motwani, Naoka Murakami, Rimda Wanchoo, David I Ortiz-Melo, Arash Rashidi, Ben Sprangers, Vikram Aggarwal, A Bilal Malik, Sebastian Loew, Christopher A Carlos, Pazit Beckerman, Zain Mithani, Chintan V Shah, Amanda D Renaghan, Sophie De Seigneux, Luca Campedel, Daniel Sanghoon Shin, Sunil Rangarajan, Priya Deshpande, Gaia Coppock, Dwight H. Owen, Marium Husain, Clara Garcia-Carro, Sheila Bermejo, Nuttha Lumlertgul, Nina Seylanova, Busra Isik, Aydin Kaghazchi, Yuriy Khanin, Sheru K Kansal, Kai M Schmidt-Ott, Raymond K Hsu, Maria C Tio, Suraj Sarvode Mothi, Harkarandeep Singh, Kenar D Jhaveri, David E Leaf, Corinne Isnard Bagnis, Suraj S Mothi, Weiting Chang, Vipulbhai Sakhiya, Daniel Stalbow, Sylvia Wu, Armando Cennamo, Anne Rigg, Nisha Shaunak, Zoe A Kibbelaar, Harish S Seethapathy, Meghan Lee, Ian A Strohbhen, Ilya G Glezerman, Dwight H Owen, Sharon Mini, Andrey Kisel, Nicole Albert, Katherine Carter, Vicki Donley, Tricia Young, Heather Cigoi, Els Wauters Ben Sprangers, Javier A Pagan, Jonathan J Hogan, Valda Page, Samuel AP Short, Maria Josep Carreras, Institut Català de la Salut, [Gupta S] Division of Renal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA. [Short SAP] University of Vermont Larner College of Medicine, Burlington, Vermont, USA. [Sise ME] Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA. [Prosek JM, Madhavan SM] Division of Nephrology, Department of Internal Medicine, The Ohio State University Medical Center, Columbus, Ohio, USA. [Soler MJ, Bermejo S] Servei de Nefrologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain. [Ostermann M] Servei de Nefrologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain. Nephrology Department, San Carlos Clinical University Hospital, Madrid, Spain, and Vall d'Hebron Barcelona Hospital Campus
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Male ,Cancer Research ,ACUTE INTERSTITIAL NEPHRITIS ,Immunoteràpia ,Other subheadings::Other subheadings::/drug therapy [Other subheadings] ,urologic and male genital diseases ,THERAPY ,Gastroenterology ,Cohort Studies ,Risk Factors ,Immunology and Allergy ,Immune Checkpoint Inhibitors ,RC254-282 ,RISK ,Clinical/Translational Cancer Immunotherapy ,Kidney ,medicine.diagnostic_test ,terapéutica::terapia biológica::inmunomodulación::inmunoterapia [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] ,Acute kidney injury ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Acute Kidney Injury ,Middle Aged ,female genital diseases and pregnancy complications ,medicine.anatomical_structure ,Oncology ,Molecular Medicine ,Female ,immunotherapy ,Life Sciences & Biomedicine ,CTLA-4 antigen ,medicine.medical_specialty ,enfermedades urogenitales masculinas::enfermedades urológicas::enfermedades renales::insuficiencia renal::lesión renal aguda [ENFERMEDADES] ,medicine.drug_class ,Immunology ,Otros calificadores::Otros calificadores::/farmacoterapia [Otros calificadores] ,Proton-pump inhibitor ,Renal function ,programmed cell death 1 receptor ,EVENTS ,Internal medicine ,Biopsy ,medicine ,Humans ,Adverse effect ,Acute tubulointerstitial nephritis ,Aged ,Pharmacology ,Science & Technology ,Therapeutics::Biological Therapy::Immunomodulation::Immunotherapy [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] ,urogenital system ,business.industry ,Proportional hazards model ,CLINICAL-FEATURES ,medicine.disease ,Male Urogenital Diseases::Urologic Diseases::Kidney Diseases::Renal Insufficiency::Acute Kidney Injury [DISEASES] ,business ,Ronyons - Malalties - Tractament - Abstract
BackgroundImmune checkpoint inhibitor-associated acute kidney injury (ICPi-AKI) has emerged as an important toxicity among patients with cancer.MethodsWe collected data on 429 patients with ICPi-AKI and 429 control patients who received ICPis contemporaneously but who did not develop ICPi-AKI from 30 sites in 10 countries. Multivariable logistic regression was used to identify predictors of ICPi-AKI and its recovery. A multivariable Cox model was used to estimate the effect of ICPi rechallenge versus no rechallenge on survival following ICPi-AKI.ResultsICPi-AKI occurred at a median of 16 weeks (IQR 8–32) following ICPi initiation. Lower baseline estimated glomerular filtration rate, proton pump inhibitor (PPI) use, and extrarenal immune-related adverse events (irAEs) were each associated with a higher risk of ICPi-AKI. Acute tubulointerstitial nephritis was the most common lesion on kidney biopsy (125/151 biopsied patients [82.7%]). Renal recovery occurred in 276 patients (64.3%) at a median of 7 weeks (IQR 3–10) following ICPi-AKI. Treatment with corticosteroids within 14 days following ICPi-AKI diagnosis was associated with higher odds of renal recovery (adjusted OR 2.64; 95% CI 1.58 to 4.41). Among patients treated with corticosteroids, early initiation of corticosteroids (within 3 days of ICPi-AKI) was associated with a higher odds of renal recovery compared with later initiation (more than 3 days following ICPi-AKI) (adjusted OR 2.09; 95% CI 1.16 to 3.79). Of 121 patients rechallenged, 20 (16.5%) developed recurrent ICPi-AKI. There was no difference in survival among patients rechallenged versus those not rechallenged following ICPi-AKI.ConclusionsPatients who developed ICPi-AKI were more likely to have impaired renal function at baseline, use a PPI, and have extrarenal irAEs. Two-thirds of patients had renal recovery following ICPi-AKI. Treatment with corticosteroids was associated with improved renal recovery.
- Published
- 2021