Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Jul;149(8):5061-5070.
doi: 10.1007/s00432-022-04437-9. Epub 2022 Nov 3.

Acute kidney injury in advanced lung cancer patients treated with PD-1 inhibitors: a single center observational study

Kang Liu #  1 , Zhongke Qin #  1   2 , Yifei Ge  1 , Ao Bian  1 , Xueqiang Xu  1 , Buyun Wu  1 , Changying Xing  1 , Huijuan Mao  3
Affiliations
Review

Acute kidney injury in advanced lung cancer patients treated with PD-1 inhibitors: a single center observational study

Kang Liu et al. J Cancer Res Clin Oncol. 2023 Jul.

Abstract

Purpose: Immune checkpoint inhibitor (ICI) therapy is now the stand of care for lung cancer. Due to the low incidence, the study of acute kidney injury (AKI) in lung cancer patients treated with ICIs was hardly reported. We focused on the incidence, characteristics, risk factors, and mortality of AKI in advanced lung cancer patients receiving PD-1 inhibitors.

Methods: We reviewed advanced lung cancer patients receiving PD-1 inhibitors between January 2018 to August 2020 at Jiangsu Province Hospital. Patients were followed up for 6 months. We used the logistic regression model to evaluate risk factors for AKI, and Kaplan-Meier method to assess the association between AKI and mortality.

Results: A total of 305 advanced lung cancer patients treated with PD-1 inhibitors. The median age was 64 years and 80.6% of patients were male. The incidence of AKI was 10.2%, and the incidence of ICI-AKI was 4.6%. Multivariate analysis showed that concomitant use of nonsteroidal anti-inflammatory drugs (NSAIDs) (OR 2.509; 95% CI 1.053-5.974) and renin-angiotensin-aldosterone system (RAAS) inhibitors (OR 2.656; 95% CI 1.091-6.466) were risk factors for AKI. In addition, concomitant use of NSAIDs (OR 5.170; 95% CI 1.087-24.595) and RAAS inhibitors (OR 5.921; 95% CI 1.871-18.737), and the occurrence of extra-renal immune-related adverse events (OR 4.726; 95% CI 1.462-15.280) were significantly associated with ICI-AKI. ICI-AKI was not associated with mortality while severe AKI was associated with higher risk of mortality.

Conclusion: AKI is common in advanced lung cancer patients treated with PD-1 inhibitors. The characteristics and risk factors of ICI-AKI were similar to those previously reported in other solid organ malignancies treated with ICIs. Severe AKI may indicate higher mortality.

Keywords: Acute kidney injury; Advanced lung cancer; Adverse event; Immunotherapy; Programmed cell death 1 inhibitor.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart. AKI acute kidney injury, ICI immune checkpoint inhibitor, JSPH Jiangsu Province Hospital, PD-1 programmed cell death 1, Scr serum creatinine
Fig. 2
Fig. 2
Kaplan–Meier curves for the 97-day landmark analysis of OS in patients with severe AKI and without severe AKI. p = 0.016 by log-rank test. AKI acute kidney injury, OS overall survival
Fig. 3
Fig. 3
Kaplan–Meier curves for the 97-day landmark analysis of OS in patients with non-AKI, ICI-AKI, and non-ICI-AKI. p = 0.275 (non-AKI VS ICI-AKI), 0.081 (non-AKI VS non-ICI-AKI), and 0.072 (ICI-AKI VS non-ICI-AKI) by log-rank test. AKI acute kidney injury, ICI-AKI immune checkpoint inhibitor-associated acute kidney injury, OS overall survival
See this image and copyright information in PMC

References

    1. Baker ML, Yamamoto Y, Perazella MA, Dizman N, Shirali AC, Hafez N et al (2022) Mortality after acute kidney injury and acute interstitial nephritis in patients prescribed immune checkpoint inhibitor therapy. J Immunother Cancer. 10.1136/jitc-2021-004421 - PMC - PubMed
    1. Borghaei H, Paz-Ares L, Horn L, Spigel DR, Steins M, Ready NE et al (2015) Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. N Engl J Med 373:1627–1639. 10.1056/NEJMoa1507643 - PMC - PubMed
    1. Brahmer J, Reckamp KL, Baas P, Crino L, Eberhardt WE, Poddubskaya E et al (2015) Nivolumab versus docetaxel in advanced squamous-cell non-small-cell lung cancer. N Engl J Med 373:123–135. 10.1056/NEJMoa1504627 - PMC - PubMed
    1. Brahmer JR, Lacchetti C, Thompson JA (2018) Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American Society of Clinical Oncology clinical practice guideline summary. J Oncol Pract 14:247–249. 10.1200/JOP.18.00005 - PubMed
    1. Carbone DP, Reck M, Paz-Ares L, Creelan B, Horn L, Steins M et al (2017) First-line nivolumab in stage IV or recurrent non-small-cell lung cancer. N Engl J Med 376:2415–2426. 10.1056/NEJMoa1613493 - PMC - PubMed

Substances

LinkOut - more resources