Departments of Medical Oncology.
Internal Medicine.
Anticancer Drugs. 2023 Jul 1;34(6):783-790. doi: 10.1097/CAD.0000000000001463. Epub 2022 Dec 19.
Recent observational studies reported acute kidney injury (AKI) events in over 10% of the patients treated with immune checkpoint inhibitors (ICIs). However, these studies included patients treated in high-resource settings and earlier lines. Therefore, we aimed to assess the AKI rates and predisposing factors in ICI-treated patients from a limited resource setting. We evaluated 252 patients with advanced cancer for this retrospective cohort study. AKI events were defined by Kidney Disease Improving Global Outcomes criteria. The median age was 59 years. The melanoma (18.3%), non-small cell lung cancer (14.7%) and renal cell carcinoma (22.6%) patients comprised over half of the cohort. During the follow-up, 45 patients (17.9%) had at least one AKI episode. In multivariable analyses, patients with chronic kidney disease (CKD) [odds ratio (OR), 3.385; 95% confidence interval (CI), 1.510-7.588; P = 0.003], hypoalbuminemia (OR, 2.848; 95% CI, 1.225-6.621; P = 0.015) or renin-angiotensin-aldosterone system (RAAS) inhibitor use (OR, 2.236; 95% CI, 1.017-4.919; P = 0.045) had increased AKI risk. There was a trend towards increased AKI risk in patients with diabetes (OR, 2.042; 95% CI, 0.923-4.518; P = 0.78) and regular proton pump inhibitors use (OR, 2.024; 95% CI, 0.947-4.327; P = 0.069). In this study, we observed AKI development under ICIs in almost one in five patients with cancer. The increased AKI rates in CKD, hypoalbuminemia or RAAS inhibitor use pointed out a need for better onco-nephrology collaboration and efforts to improve the nutritional status of ICI-treated patients.
最近的观察性研究报告称，接受免疫检查点抑制剂 (ICI) 治疗的患者中超过 10%发生急性肾损伤 (AKI) 事件。然而，这些研究纳入了在高资源环境中接受治疗和更早线治疗的患者。因此，我们旨在评估来自资源有限环境的 ICI 治疗患者的 AKI 发生率和易患因素。我们对 252 名晚期癌症患者进行了这项回顾性队列研究。AKI 事件根据肾脏疾病改善全球结果 (KDIGO) 标准定义。中位年龄为 59 岁。黑色素瘤 (18.3%)、非小细胞肺癌 (14.7%) 和肾细胞癌 (22.6%) 患者占队列的一半以上。在随访期间，45 名患者 (17.9%) 至少发生了一次 AKI 事件。多变量分析显示，慢性肾脏病 (CKD) 患者 [比值比 (OR)，3.385；95%置信区间 (CI)，1.510-7.588；P = 0.003]、低白蛋白血症 (OR，2.848；95%CI，1.225-6.621；P = 0.015) 或肾素-血管紧张素-醛固酮系统 (RAAS) 抑制剂使用者 (OR，2.236；95%CI，1.017-4.919；P = 0.045) 发生 AKI 的风险增加。糖尿病患者 (OR，2.042；95%CI，0.923-4.518；P = 0.78) 和常规质子泵抑制剂使用者 (OR，2.024；95%CI，0.947-4.327；P = 0.069) 发生 AKI 的风险呈增加趋势。在这项研究中，我们观察到癌症患者中有近五分之一在接受 ICI 治疗后出现 AKI 发展。CKD、低白蛋白血症或 RAAS 抑制剂使用者 AKI 发生率增加表明需要更好的肿瘤肾病学合作，并努力改善 ICI 治疗患者的营养状况。
