The Incidence, Causes, and Risk Factors of Acute Kidney Injury in Patients Receiving Immune Checkpoint Inhibitors
The Incidence, Causes, and Risk Factors of Acute Kidney Injury in Patients Receiving Immune Checkpoint Inhibitors
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DOI：
10.2215/cjn.00990119
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发表时间：
2019-12-06
影响因子：
9.8
通讯作者：
Sise, Meghan E.
中科院分区：
文献类型：
--
作者：
Seethapathy, Harish;Zhao, Sophia;Sise, Meghan E.
背景和目的免疫检查点抑制剂在肿瘤学中的应用正在迅速增加。我们试图确定接受检查点抑制剂治疗的真实人群中阿基的频率、严重程度、原因和预测因素。设计、设置、参与者和测量我们纳入了2011年5月至2016年12月在马萨诸塞州总医院接受检查点抑制剂治疗的所有患者。将检查点抑制剂开始日期前6个月的平均基线血清肌酐与开始治疗后12个月内的所有后续肌酐值进行比较。阿基定义为肾脏疾病：改善肌酐较基线倍数变化的全球结局标准。持续性阿基事件持续至少3天，是我们的主要结局。通过病历审查确定持续性阿基的原因。使用累积发生率和子分布风险模型评估基线人口统计学、合并症和药物与持续阿基和潜在检查点抑制剂之间的关系。结果我们纳入了1016例患者的分析。平均年龄为63岁（SD 13），61%为男性，91%为白色。平均基线肌酐为0.9 mg/dl（SD 0.4 mg/dl），169例（17%）患有CKD（eGFR
Background and objectivesImmune checkpoint inhibitor use in oncology is increasing rapidly. We sought to determine the frequency, severity, cause, and predictors of AKI in a real-world population receiving checkpoint inhibitors.Design, setting, participants, & measurementsWe included all patients who received checkpoint inhibitor therapy from May 2011 to December 2016 at Massachusetts General Hospital. Baseline serum creatinine, averaged 6 months before checkpoint inhibitor start date, was compared with all subsequent creatinine values within 12 months of starting therapy. AKI was defined by Kidney Disease: Improving Global Outcomes criteria for fold changes in creatinine from baseline. Sustained AKI events lasted at least 3 days and was our primary outcome. The cause of sustained AKI was determined by chart review. Cumulative incidence and subdistribution hazard models were used to assess the relationship between baseline demographics, comorbidities, and medications, and sustained AKI and potential checkpoint inhibitor?related AKI.ResultsWe included 1016 patients in the analysis. Average age was 63 (SD 13) years, 61% were men, and 91% were white. Mean baseline creatinine was 0.9 mg/dl (SD 0.4 mg/dl), and 169 (17%) had CKD (eGFR