MANAGEMENT OF IMMUNE CHECKPOINT INHIBITOR RELATED ACUTE KIDNEY INJURY: A LOCAL CLINICAL PRACTICE GUIDELINE
Dr Emily Qian1,2, Dr Kim Tam Bui1,3,4, Dr Anthony Linton1,3,4, A/Prof Muh Geot Wong1,2,4
1Concord Repatriation General Hospital, Sydney, Australia, 2Department of Renal Medicine, Concord Repatriation General Hospital, Sydney, Australia, 3Department of Medical Oncology, Concord Repatriation General Hospital, Sydney, Australia, 4Concord Clinical School, The University of Sydney, Sydney, Australia
Aim: To develop a local clinical practice guideline (CPG) to manage patients with immune check point inhibitor (ICI)-related acute kidney injury (irAKI).
Background: ICIs have proven efficacy in various cancers across different stages. irAKI is a rare but potentially severe immune-related adverse event associated with ICIs. Early recognition and prompt treatment, often involving multidisciplinary teams, is essential. Current clinical resources provide general advice on irAKI, but specific guidelines are required to enable comprehensive evaluation of irAKI and early initiation of organ-saving treatment.
Methods: A review of the literature and current clinical resources was conducted. Information was compiled into a CPG, considering local resource availability and referral pathways. Iterations of the guideline were made after repeated consultations with local nephrologists and medical oncologists.
Results: The literature review yielded retrospective studies which focused on AKI severity and patterns of steroid management. Clinical resources from eviQ and the American Society of Clinical Oncology were reviewed. Consensus was reached on the evaluation of AKI in patients on ICIs, severity-stratified immunosuppression in suspected or biopsy-proven irAKI, frequency of monitoring of renal injury, corticosteroid tapering, and ICI rechallenge. Wording was scrutinised to avoid sub-specialty jargon, to ensure specific advice in time-sensitive scenarios, and to encourage utilisation by clinicians less familiar with ICIs. Implementation of the final CPG occurred through specialty-specific and hospital-wide education and publication to the local intranet.
Conclusion: A local CPG for managing AKI in patients on ICIs in a tertiary Australian hospital was established. Multidisciplinary input was integral to ensure cross-specialty usability, with a stepwise process that can be refined to other clinical settings. The uptake and feasibility of this guideline will be monitored to inform future revisions.
Biography:
Dr Emily Qian is a renal advanced trainee at Concord Repatriation General Hospital. She has an interest in acute kidney, glomerulonephritis and immune-related pathology involving the kidney. She has played a role in multiple innovations within tertiary hospitals across Western and the Sydney local health district, and is interested in improving medical education and access to resources to inform clinical decision making at all levels.