ACUTE kidney injury (AKI) affected nearly one-third of patients receiving immune checkpoint inhibitor (ICI) therapy, with acute tubular necrosis and transient azotaemia associated with increased mortality, according to a retrospective study of 943 adults.
The findings highlighted the importance of distinguishing between conventional and immune-mediated causes of kidney injury, as different subtypes demonstrated distinct risk factors and prognostic implications.
Researchers retrospectively analysed 943 adults treated with immune checkpoint inhibitors at Korea University Anam Hospital between 2015 and 2024, investigating the incidence, risk factors, and clinical outcomes of AKI.
Kidney injury occurring within 12 months of treatment initiation was defined using Kidney Disease: Improving Global Outcomes criteria. Cases were categorised as transient azotaemia, characterised by recovery within 72 hours, or sustained AKI lasting longer than 72 hours.
Sustained cases included acute tubular necrosis (ATN), obstruction, and ICI-associated AKI, allowing researchers to assess differences between conventional and immune-mediated mechanisms.
Overall, AKI occurred in 32.1% of patients. ATN was the most frequently identified subtype, followed by transient azotaemia, obstruction, and immune-mediated acute tubulointerstitial nephritis.
The analysis identified different clinical characteristics associated with specific forms of kidney injury.
Pre-existing chronic kidney disease and proton pump inhibitor use emerged as independent risk factors for immune-mediated AKI.
In contrast, lower serum albumin concentrations, elevated C-reactive protein levels, and hepatobiliary cancers were associated with ATN.
These findings suggested that the clinical characteristics associated with kidney injury varied according to the underlying mechanism, potentially supporting more targeted assessment of patients receiving immunotherapy.
Transient azotaemia and ATN were independently associated with increased mortality, highlighting the prognostic significance of kidney injury beyond immune-mediated complications.
ICI-associated AKI also demonstrated a statistically significant association with mortality. However, researchers characterised this relationship as modest and emphasised that interpretation required caution because only 25 cases were identified.
Overall, the findings indicated that ATN and transient azotaemia occurred more frequently than immune-mediated kidney injury and were associated with poorer prognosis.
Recognising subtype-specific risk factors may help clinicians identify AKI earlier, distinguish potential underlying mechanisms, and optimise management strategies for patients undergoing immune checkpoint inhibitor therapy.
Reference
Seo YB et al. Incidence, risk factors, and mortality of acute kidney injury in patients receiving immune checkpoint inhibitors: analysis by acute kidney injury subtype. Kidney Res Clin Pract. 2026. doi: 10.23876/j.krcp.25.410
Image credit: Adobestock/Sewcream studio
Image credit: Adobestock/Sewcream studio
Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.
