Predictors of Acute Kidney Injury in Patients Prescribed Immune Checkpoint Inhibitor Therapy and Their Association with Death: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis evaluated acute kidney injury (AKI) in 24,953 cancer patients treated with immune checkpoint inhibitors (ICIs) across 29 studies.

Key findings:

• Overall AKI incidence: 16.2% (95% CI 12.8–19.8).
• Immune checkpoint inhibitor–associated AKI (ICPi-AKI) incidence: 3.1% (95% CI 2.4–4.0).
• Non–ICPi-AKI incidence: 11.2% (95% CI 8.4–14.3).
• Sustained AKI: 14.9% (95% CI 7.5–24.3).

Prognosis:

• AKI and mortality: AKI (HR 1.521, 95% CI 1.208–1.916) was associated with increased all-cause mortality.
• ICPi-AKI and mortality: ICPi-AKI (HR 1.407, 95% CI 1.059–1.869) was associated with increased all-cause mortality.

Risk factors for AKI:

• Preexisting chronic kidney disease.
• Concomitant extrarenal immune-related adverse events.
• Concomitant medications: NSAIDs, PPIs, diuretics, RAAS inhibitors, antibiotics, and “fluidone” (as reported in the abstract).

Treatment-related signals:

• Combination ICI therapy: produced more renal injury than monotherapy.
• Ipilimumab vs nivolumab: ipilimumab users had higher AKI risk than those on nivolumab.
• CTLA-4 blockade vs PD-1: more associated with sustained AKI.
• PD-L1 blockade vs PD-1: more associated with ICPi-AKI.

Overall conclusion: AKI is relatively common in patients on ICIs, is associated with worse survival, and is influenced by baseline kidney function, concurrent toxicities, nephrotoxic co-medications, and specific ICI class/regimen, underscoring the need for vigilant renal monitoring and medication review in this population.