Dr Jyothirmaye Kuppa1, Nitesh Rao1, Rajiv Juneja1, Caroline Milton1
1Renal Unit, Flinders Medical Centre, Bedford Park, Australia
Biography:
Dr Jyothi Kuppa is a final-year Renal Advanced Trainee based in Adelaide, currently completing her training at the Royal Adelaide Hospital. For her advanced trainee project, she investigated the rates and clinical practices surrounding immune checkpoint inhibitors at a local centre, addressing a key gap in current evidence.
Aim:
The aim of this retrospective observational study was to examine and summarise the rates, practice and outcomes of acute kidney injury (AKI) related to immune checkpoint inhibitors (ICI), at Flinders Medical Centre (FMC), South Australia.
Background:
ICIs are a novel class of immunotherapy that has become widely prescribed in recent years, significantly improving cancer prognosis. However, these benefits are sometimes accompanied by immune-related adverse effects (IRAEs), including AKI.
Methods:
Adult patients who received anti-PD-1/PDL1/CTLA4 antibody therapy at FMC between January 2020-2023 were enrolled. Clinical and laboratory data were collected from patient records, and the incidence of AKI was determined. ICI-AKI was defined based on either evidence of delayed or discontinued ICI due to suspected ICI-AKI, kidney biopsy evidence of tubulointerstitial nephritis, or corticosteroid treatment for suspected ICI-AKI. Data on kidney biopsy, corticosteroid use, ICI rechallenge, AKI recurrence and renal recovery were also collected in the ICI-AKI group.
Results:
A total of 507 patients were included. 58 patients (11.4%) developed AKI, with 11 cases (2.2%) attributed to ICI. Combination immunotherapy with PD-1/PD-L1 and CTLA-4 inhibitor, and a lower baseline eGFR were more common in the ICI-AKI cohort. Median time to AKI was 83 days after the first ICI cycle; median number of cycles was 4. Corticosteroids were used in 8 of 11 patients. Kidney biopsies in four patients confirmed tubulointerstitial nephritis. Four patients were rechallenged with ICI; one had recurrent AKI. One required renal replacement therapy, and two had renal recovery.
Conclusions:
In our cohort, AKI occurred at a notable frequency in patients treated with ICIs, though ICI related AKI necessitating treatment discontinuation was infrequent.
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