#2957 Immune checkpoint inhibitors associated acute kidney injury: a case series

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Abstract Background and Aims Immune checkpoint inhibitors (ICIs) have become a cornerstone in cancer treatment, improving overall survival in many patients. However, their use is associated with immune-related adverse events (irAEs), including rare but significant renal complications. Immune checkpoint inhibitor-associated acute kidney injury (ICI-AKI) can affect kidney function, complicate cancer outcomes, and interfere with ongoing cancer treatment. This study aims to describe our experience in managing ICI-AKI and evaluate long-term outcomes. Method This case series includes patients diagnosed with ICI-AKI (defined according to KDIGO criteria), between 2017 and 2025, as confirmed by clinical symptoms or biopsy, excluding kidney transplant recipients. Baseline demographic data, clinical course, management strategies, and outcomes are presented. Kidney function recovery was defined as serum creatinine ≤ 1.5 times baseline creatinine before AKI at 90 days. Results We identified 22 patients with ICI-AKI, 54.5% of whom were male, with a mean age of 70.1 ± 9.5 years. The mean interval between the initiation of ICI therapy and AKI onset was 106.5 days (IQR 55–251). The mean interval between the last injection of ICI and AKI onset was 70.5 days. Pre-ICI chronic kidney disease (eGFR < 60 ml/min) was present in 18.2% of patients and the mean of creatinine was 0.98 +/– 0.28 mg/dL. Proton pump inhibitors (PPI) were used in 63.6% of patients, while only a few were on NSAIDs (9.1%) or antibiotics (13.6%) prior to or during ICI therapy. Other irAEs were observed in 54.5% of the cohort. The mean peak plasma creatinine level was 3.2 ± 1.7 mg/dL, and the mean estimated glomerular filtration rate (eGFR) at the time of AKI was 21.5 ± 10.2 ml/min. ICI therapy was withheld in 17 patients, and 18 patients received corticosteroid treatment for a median duration of 74 days (IQR 25–105). Only 2 patients required additional immunosuppression: one with Infliximab for severe Fanconi syndrome, and another with Rituximab for membranous nephropathy. Kidney function fully recovered in 12 patients, partially recovered in 6, and did not recover in 4. Rechallenge with ICI therapy was attempted in 2 patients. In terms of cancer response, 15 patients (68.1%) had an overall response (complete or partial), while 3 (13.6%) had stable disease and 4 (18.2%) had progressive disease. The median survival in our cohort was 3.03 years, with a median time to death of 377 days (IQR 233–781) following ICI initiation. (Fig. 1). Conclusion ICI-AKI, although rare, presents as a late-onset complication and is associated with poor renal outcomes and high corticosteroid use. Despite this, the cancer response rate in our cohort was favorable, with an overall response rate of 68.1%. Future studies are needed to optimize the management of ICI-AKI and its impact on long-term patient outcomes.

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