Immune checkpoint inhibitor-associated acute kidney injury and mortality: An observational study.

<h4>Background</h4>Immune checkpoint inhibitors, approved for the treatment of various types of cancer, are known to cause a unique spectrum of side effects, including acute kidney injury (AKI). The aim of this study was to describe the incidence, risk factors, renal outcomes, and mortal...

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Autores principales:	Marije S Koks, Gurbey Ocak, Britt B M Suelmann, Cornelia A R Hulsbergen-Veelken, Saskia Haitjema, Marieke E Vianen, Marianne C Verhaar, Karin A H Kaasjager, Meriem Khairoun
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/144c8c5576d040aa8607d7a60a1e893b
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spelling	oai:doaj.org-article:144c8c5576d040aa8607d7a60a1e893b2021-12-02T20:10:58ZImmune checkpoint inhibitor-associated acute kidney injury and mortality: An observational study.1932-620310.1371/journal.pone.0252978https://doaj.org/article/144c8c5576d040aa8607d7a60a1e893b2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0252978https://doaj.org/toc/1932-6203<h4>Background</h4>Immune checkpoint inhibitors, approved for the treatment of various types of cancer, are known to cause a unique spectrum of side effects, including acute kidney injury (AKI). The aim of this study was to describe the incidence, risk factors, renal outcomes, and mortality of AKI in patients receiving checkpoint inhibitors.<h4>Methods</h4>Patients receiving checkpoint inhibitors between January 2013 and May 2020 at the University Medical Center Utrecht, the Netherlands, were identified using the Utrecht Patient Oriented Database. AKI was defined as an increase in serum creatinine of ≥1.5 times the baseline value, based on the Kidney Disease: Improving Global Outcomes criteria. Cox proportional hazard regression analysis was used to assess risk factors for AKI and to evaluate the relationship between AKI and mortality. Persistent renal dysfunction was diagnosed in AKI patients with a final serum creatinine measurement of >1.3 times the baseline value.<h4>Results</h4>Among 676 patients receiving checkpoint inhibitors, the overall incidence of AKI was 14.2%. Baseline variables independently associated with AKI were a gynecologic malignancy, monotherapy with ipilimumab, and the use of a diuretic, angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker, or proton pump inhibitor at baseline. AKI was checkpoint inhibitor-associated in one third of all patients with AKI. Checkpoint inhibitor-associated AKI was mostly low-grade, occurred a median of 15 weeks after checkpoint inhibitor initiation, and resulted in persistent renal dysfunction in approximately 40% of the patients. Patients with all-cause AKI had a twofold increased mortality risk, but checkpoint inhibitor-associated AKI was not associated with increased mortality.<h4>Conclusions</h4>In this study, patients receiving checkpoint inhibitors frequently developed AKI due to various etiologies. AKI directly related to the effect of checkpoint inhibitor toxicity did not increase mortality. However, AKI not related to the effect of checkpoint inhibitor toxicity was associated with increased mortality.Marije S KoksGurbey OcakBritt B M SuelmannCornelia A R Hulsbergen-VeelkenSaskia HaitjemaMarieke E VianenMarianne C VerhaarKarin A H KaasjagerMeriem KhairounPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0252978 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Marije S Koks Gurbey Ocak Britt B M Suelmann Cornelia A R Hulsbergen-Veelken Saskia Haitjema Marieke E Vianen Marianne C Verhaar Karin A H Kaasjager Meriem Khairoun Immune checkpoint inhibitor-associated acute kidney injury and mortality: An observational study.
description	<h4>Background</h4>Immune checkpoint inhibitors, approved for the treatment of various types of cancer, are known to cause a unique spectrum of side effects, including acute kidney injury (AKI). The aim of this study was to describe the incidence, risk factors, renal outcomes, and mortality of AKI in patients receiving checkpoint inhibitors.<h4>Methods</h4>Patients receiving checkpoint inhibitors between January 2013 and May 2020 at the University Medical Center Utrecht, the Netherlands, were identified using the Utrecht Patient Oriented Database. AKI was defined as an increase in serum creatinine of ≥1.5 times the baseline value, based on the Kidney Disease: Improving Global Outcomes criteria. Cox proportional hazard regression analysis was used to assess risk factors for AKI and to evaluate the relationship between AKI and mortality. Persistent renal dysfunction was diagnosed in AKI patients with a final serum creatinine measurement of >1.3 times the baseline value.<h4>Results</h4>Among 676 patients receiving checkpoint inhibitors, the overall incidence of AKI was 14.2%. Baseline variables independently associated with AKI were a gynecologic malignancy, monotherapy with ipilimumab, and the use of a diuretic, angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker, or proton pump inhibitor at baseline. AKI was checkpoint inhibitor-associated in one third of all patients with AKI. Checkpoint inhibitor-associated AKI was mostly low-grade, occurred a median of 15 weeks after checkpoint inhibitor initiation, and resulted in persistent renal dysfunction in approximately 40% of the patients. Patients with all-cause AKI had a twofold increased mortality risk, but checkpoint inhibitor-associated AKI was not associated with increased mortality.<h4>Conclusions</h4>In this study, patients receiving checkpoint inhibitors frequently developed AKI due to various etiologies. AKI directly related to the effect of checkpoint inhibitor toxicity did not increase mortality. However, AKI not related to the effect of checkpoint inhibitor toxicity was associated with increased mortality.
format	article
author	Marije S Koks Gurbey Ocak Britt B M Suelmann Cornelia A R Hulsbergen-Veelken Saskia Haitjema Marieke E Vianen Marianne C Verhaar Karin A H Kaasjager Meriem Khairoun
author_facet	Marije S Koks Gurbey Ocak Britt B M Suelmann Cornelia A R Hulsbergen-Veelken Saskia Haitjema Marieke E Vianen Marianne C Verhaar Karin A H Kaasjager Meriem Khairoun
author_sort	Marije S Koks
title	Immune checkpoint inhibitor-associated acute kidney injury and mortality: An observational study.
title_short	Immune checkpoint inhibitor-associated acute kidney injury and mortality: An observational study.
title_full	Immune checkpoint inhibitor-associated acute kidney injury and mortality: An observational study.
title_fullStr	Immune checkpoint inhibitor-associated acute kidney injury and mortality: An observational study.
title_full_unstemmed	Immune checkpoint inhibitor-associated acute kidney injury and mortality: An observational study.
title_sort	immune checkpoint inhibitor-associated acute kidney injury and mortality: an observational study.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/144c8c5576d040aa8607d7a60a1e893b
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Immune checkpoint inhibitor-associated acute kidney injury and mortality: An observational study.

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