Wu Yuemeng, Luo Lingfan, Sun Xin, Ye Xiaolan, Ren Yan, Zhang Wei, Bu Shuangshan, Li Yiwen, Zhu Bin, Shao Lina
Department of Nephrology, Dongyang Hospital (Affiliated Wenzhou Medical University), Jinhua, Zhejiang, China.
Urology & Nephrology Center, Department of Nephrology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
PeerJ. 2025 Aug 26;13:e19886. doi: 10.7717/peerj.19886. eCollection 2025.
Immune checkpoint inhibitors (ICIs) have improved cancer survival but increase the risk of adverse events, including acute kidney injury (AKI). Severe AKI, though rare, can disrupt treatment and worsen outcomes. Yet, research on risk factors for severe AKI in patients on PD-1/PD-L1 therapies is limited. This study aimed to identify these risk factors.
This retrospective cohort study analyzed electronic medical records from Zhejiang Provincial People's Hospital from January 2019 to July 2023. In total, 907 patients who met the inclusion criteria, with a median age of 64 years, were included in the analysis. Least Absolute Shrinkage and Selection Operator (LASSO) and Cox regression analyses were conducted to determine independent risk factors for severe AKI.
Severe AKI was observed in 3.2% of patients with AKI, with a significantly higher mortality rate than in non-AKI patients (20.7% 4.1%) during the follow-up period. Multivariate Cox regression analysis identified elevated gamma-glutamyl transferase (hazard ratio (HR): 1.17), diuretic use (HR: 3.61), nonsteroidal anti-inflammatory drug (NSAID) use (HR: 4.58), and cytotoxic drugs (HR: 5.04) as independent risk factors for severe AKI. Only 11 patients (37.5%) with severe AKI recovered.
This study highlights the importance of monitoring these factors to reduce the risk of severe AKI in patients receiving PD-1/PD-L1 antibody therapy.
免疫检查点抑制剂（ICIs）提高了癌症患者的生存率，但增加了包括急性肾损伤（AKI）在内的不良事件风险。严重AKI虽罕见，但会中断治疗并使预后恶化。然而，关于接受PD-1/PD-L1治疗的患者发生严重AKI的危险因素的研究有限。本研究旨在确定这些危险因素。
这项回顾性队列研究分析了浙江省人民医院2019年1月至2023年7月的电子病历。共有907名符合纳入标准的患者纳入分析，中位年龄为64岁。采用最小绝对收缩和选择算子（LASSO）及Cox回归分析来确定严重AKI的独立危险因素。
在发生AKI的患者中，3.2%出现了严重AKI，在随访期间，其死亡率显著高于未发生AKI的患者（20.7%对4.1%）。多变量Cox回归分析确定，γ-谷氨酰转移酶升高（风险比（HR）：1.17）、使用利尿剂（HR：3.61）、使用非甾体抗炎药（NSAID）（HR：4.58）和使用细胞毒性药物（HR：5.04）是严重AKI的独立危险因素。只有11名（37.5%）严重AKI患者康复。
本研究强调了监测这些因素对于降低接受PD-1/PD-L1抗体治疗患者发生严重AKI风险的重要性。
