Incidence, predictors, and survival impact of acute kidney injury in patients with melanoma treated with immune checkpoint inhibitors: a 10-year single-institution analysis.
Incidence, predictors, and survival impact of acute kidney injury in patients with melanoma treated with immune checkpoint inhibitors: a 10-year single-institution analysis.
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DOI：
10.1080/2162402x.2021.1927313
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发表时间：
2021-05-23
期刊：
影响因子：
7.2
通讯作者：
Abudayyeh A
中科院分区：
文献类型：
--
作者：
Abdelrahim M;Mamlouk O;Lin H;Lin J;Page V;Abdel-Wahab N;Swan J;Selamet U;Yee C;Diab A;Suki W;Abudayyeh A
背景：据报道，肾脏免疫相关不良事件（irAE）的发生率为3.8%，急性肾损伤（阿基）的定义各不相同。本研究报告了MD安德森癌症中心诊断为黑色素瘤并接受免疫检查点抑制剂（ICI）治疗的患者的10年经验，并评价了阿基的发生率、相关因素及其与总生存期的相关性。研究方法：对接受伊匹单抗、纳武单抗、派姆单抗或atezolizumab治疗的所有黑色素瘤患者进行了回顾性病历审查（2010-2019年）。提取所有可用的血清肌酐数据，并使用CKD Epi方程计算估计的GFR（eGFR），并使用两个KDIGO（肾脏疾病：改善全球结局）标准诊断阿基，用于定义1664例独特患者的I期阿基。在存在死亡作为竞争风险的情况下，计算了开始ICI后阿基的累积发生率。在单变量和多变量分析中评价协变量对阿基累积发生率函数的影响。根据阿基的发生情况，采用Kaplan-Meier法估计总生存期。结果：阿基的发生率按定义1a和1b分别为3.49%和3.33%。裁定后，在每个定义中，可归因于ICI的阿基分别占阿基总发生率的58%和65%。年龄增加与阿基风险降低相关。亚洲人种与阿基的高风险相关。合并症与阿基风险增加无关，而质子泵抑制剂（PPI）、易普利姆玛或ICI联合用药与阿基显著相关。阿基与总生存率无显著相关性。免疫相关不良事件（irAE）发生在30%的阿基患者中，但其发生率在可归因于ICI的阿基患者与其他阿基患者中无差异。结论：在大量接受ICI治疗的黑色素瘤患者人群中，提供了ICI使用背景下阿基的准确记录和相关预测因素。使用ICI后的阿基不常见，与死亡率无关，与伊匹单抗、ICI联合用药和PPI的使用相关。
Background: The incidence of renal immune-related adverse events (irAEs) is reported to be 3.8%, with varied definitions of acute kidney injury (AKI). This study reports a 10-year experience at MD Anderson Cancer Center of patients diagnosed with melanoma and treated with immune checkpoint inhibitors (ICIs) and evaluated the incidence of AKI, associated factors, and its association with overall survival. Methods: A retrospective chart review (2010–2019) of all patients with melanoma treated with ipilimumab, nivolumab, pembrolizumab, or atezolizumab was performed. All available serum creatinine data were extracted and used to calculate the estimated GFR (eGFR) using the CKD Epi equation, and to diagnose AKI using the two KDIGO (Kidney Disease: Improving Global Outcomes) criteria for defining stage I AKI in 1664 unique patients. Cumulative incidence rates of AKI after initiation of ICIs were calculated in the presence of death as a competing risk. The effects of covariates on the cumulative incidence function of AKI were evaluated in a univariant and multivariable analysis. Overall survival was estimated by Kaplan–Meier method in accordance to the occurrence of AKI. Results: The incidence of AKI by definitions 1a and 1b were 3.49% and 3.33%, respectively. After adjudication, AKI attributable to ICI was 58% and 65% of the overall incidence of AKI in each definition respectively. Increasing age was associated with decreased risk of AKI. Asian race was associated with a higher risk of AKI. Comorbidities were not associated with increased risk of AKI while use of proton pump inhibitors (PPI), ipilimumab or ICI combinations were significantly associated with AKI. AKI was not significantly associated with overall survival. Immune-related adverse events (irAEs) occurred in 30% of patients with AKI but their incidence was not different in patients with AKI attributable to ICI versus other AKI. Conclusions: In a large population of patients with melanoma treated with ICIs, an accurate documentation of AKI in setting of ICI use and predictors associated is presented. AKI following ICI use is infrequent, not associated with mortality, and associated with the use of ipilimumab, ICI combinations and PPIs.