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Incidence and risk factors of acute kidney injury, and its effect on mortality among Japanese patients receiving immune check point inhibitors: a single-center observational study

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Abstract

Background

Immune checkpoint inhibitors (ICPis) are associated with multi-organ immune-related adverse effects. Here, we examined the incidence rate, recovery rate, and risk factors of acute kidney injury complicated with ICPis (ICPi-AKI) and evaluted the association between ICPi-AKI and mortality in Japanese patients.

Methods

We analyzed 152 consecutive patients receiving ICPis between 2015 and 2019. A logistic regression analysis was performed to identify risk factors for ICPi-AKI incidence and Cox regression analysis was performed to evaluate the association between ICPi-AKI and mortality.

Results

The mean patient age was 67 ± 10 years, with the median baseline serum creatinine level of 0.78 mg/dL. Twenty-seven patients (18%) developed ICPi-AKI, and 19 (73%) of them recovered. Pembrolizumab use and liver diseases were significant risk factors for the ICPi-AKI incidence. During the follow-up, 85 patients (59%) died, 17 patients (63%) with ICPi-AKI and 68 (54%) patients without ICPi-AKI, respectively. The ICPi-AKI incidence was not independently associated with mortality (adjusted hazard ratio, 0.85; 95% confidence intervals, 0.46–1.61).

Conclusions

Our finding suggest that pembrolizumab use and liver diseases are associated with a higher risk of ICPi-AKI development, but ICPi-AKI did not affect mortality. Future multi-center studies are needed to develop optimal management and prevention strategies for this complication in patients receiving ICPis.

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Acknowledgments

We would like to thank Editage (www.editage.jp) for English language editing.

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Authors and Affiliations

  1. Department of Nephrology, Teine Keijinkai Medical Center, Sapporo, Hokkaido, 0068555, Japan

    Yoshinosuke Shimamura, Shota Watanabe, Takuto Maeda, Koki Abe & Hideki Takizawa

  2. Hokkaido Renal Pathology Center, Sapporo, Hokkaido, Japan

    Yayoi Ogawa

Authors
  1. Yoshinosuke Shimamura
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  2. Shota Watanabe
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  3. Takuto Maeda
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  4. Koki Abe
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  5. Yayoi Ogawa
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  6. Hideki Takizawa
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Contributions

Conceptualization: YS and HT; Methodology: YS, SW, KA, and TM; Formal analysis and investigation: YS, YO, and SW; Writing: original draft preparation: YS; Writing: review and editing: HT; Supervision: HT.

Corresponding author

Correspondence to Yoshinosuke Shimamura.

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The authors have declared that no conflict of interest exists.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number 2-019096-00) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Shimamura, Y., Watanabe, S., Maeda, T. et al. Incidence and risk factors of acute kidney injury, and its effect on mortality among Japanese patients receiving immune check point inhibitors: a single-center observational study. Clin Exp Nephrol 25, 479–487 (2021). https://doi.org/10.1007/s10157-020-02008-1

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  • DOI: https://doi.org/10.1007/s10157-020-02008-1

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