PMID- 33607383 OWN - NLM STAT- MEDLINE DCOM- 20211004 LR - 20211004 IS - 1879-0852 (Electronic) IS - 0959-8049 (Linking) VI - 147 DP - 2021 Apr TI - Renal adverse effects of immune checkpoints inhibitors in clinical practice: ImmuNoTox study. PG - 29-39 LID - S0959-8049(21)00015-0 [pii] LID - 10.1016/j.ejca.2021.01.005 [doi] AB - BACKGROUND/OBJECTIVES: Acute Kidney Injury (AKI), induced by Checkpoint Inhibitors therapies (CPI-induced AKI), is an uncommon but severe Immune-Related Adverse Event (IRAE). The aim was to describe the epidemiology, risks factors, clinical, and laboratory characteristics of these renal adverse events (AEs) in a real-life cohort treatment. DESIGN/PARTICIPANTS: Consecutive patients undergoing a checkpoint inhibitor (CPI) therapy at the Hopital Lyon Sud from January 2015 to July 2017 were included. A systematic retrospective analysis of medical files was performed, monthly serum creatinine levels, associated treatments, and occurrence of other IRAEs data were collected. AKI episodes explained by classic AKI aetiologies (prerenal, obstructive, septic) were excluded from the analysis. RESULTS: CPI-induced AKI incidence was 3.7% (13/352) and appeared to be time-dependent (7.7% (11/143) for patients with >3 months of CPI exposure), ranging from 1 to 16 months. All cases with available histology were acute tubulointerstitial nephritis (ATIN), with poor urinary sediment. The severity of AKI was mild (stage 1 in 50% of cases), with no need for renal-replacement therapy. Although CPI-induced AKI patients had more frequently other IRAEs (77% versus 39%), this was not associated with a greater risk of AKI. Pre-existing chronic kidney disease (defined as an estimated glomerular filtration rate (eGFR) <60 ml/min) was not associated with a greater risk of CPI-induced AKI. Treatments of CPI-induced AKI were heterogeneous, with discontinuation of CPIs, and inconstant systemic corticosteroid therapy. CONCLUSION: The monitoring of renal function and early identification of AKI during CPIs treatment is essential. The optimal management of CPI-induced AKI remains unclear and requires a close collaboration between the oncology and nephrology departments. CLINICAL RELEVANCY STATEMENT: Immune checkpoint inhibitors (CPIs) have dramatically improved patient outcomes in different malignant contexts such as melanoma, non-small cell lung cancers (NSCLC) and urologic cancers. Usually well-tolerated, CPIs are however associated with immune-related adverse events (IRAEs). Among them, acute kidney injury (AKI) is uncommon, and not well-described. Following the exponential increase in the prescription of CPIs, previously uncommon cases of IRAEs (such as AKI) have become common occurrence in referral centres. Data regarding the epidemiology, risk factors, or management of CPI-induced AKI are currently lacking or can be discordant. Data regarding CPI-induced AKI, in a large real-life cohort were reported herein. CI - Copyright (c) 2021 Elsevier Ltd. All rights reserved. FAU - Espi, M AU - Espi M AD - Service de Nephrologie, Hopital Lyon Sud - Hospices Civils de Lyon, 69310, Pierre Benite, France. Electronic address: maxime.espi@chu-lyon.fr. FAU - Teuma, C AU - Teuma C AD - Service de Nephrologie, Hopital Nord Ouest, 69400, Gleize, France. FAU - Novel-Catin, E AU - Novel-Catin E AD - Service de Nephrologie, Hopital Lyon Sud - Hospices Civils de Lyon, 69310, Pierre Benite, France; ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France. FAU - Maillet, D AU - Maillet D AD - Service D'Oncologie, Hopital Lyon Sud - Hospices Civils de Lyon, 69310, Pierre Benite, France; ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France. FAU - Souquet, P J AU - Souquet PJ AD - Service de Pneumologie, Hopital Lyon Sud - Hospices Civils de Lyon, 69310, Pierre Benite, France; ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France. FAU - Dalle, S AU - Dalle S AD - Service de Dermatologie, Hopital Lyon Sud - Hospices Civils de Lyon, 69310, Pierre Benite, France; ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France. FAU - Koppe, L AU - Koppe L AD - Service de Nephrologie, Hopital Lyon Sud - Hospices Civils de Lyon, 69310, Pierre Benite, France; Univ. Lyon, CarMeN Lab, INSA-Lyon, INSERM U1060, INRA, Universite Claude Bernard Lyon 1, F-69621, Villeurbanne, France; ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France. FAU - Fouque, D AU - Fouque D AD - Service de Nephrologie, Hopital Lyon Sud - Hospices Civils de Lyon, 69310, Pierre Benite, France; ImmuCare (Immunology Cancer Research), Hospices Civils de Lyon, Lyon, France. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20210216 PL - England TA - Eur J Cancer JT - European journal of cancer (Oxford, England : 1990) JID - 9005373 RN - 0 (Immune Checkpoint Inhibitors) SB - IM MH - Acute Kidney Injury/*chemically induced/diagnosis/epidemiology/immunology MH - Aged MH - Aged, 80 and over MH - Female MH - France/epidemiology MH - Humans MH - Immune Checkpoint Inhibitors/*adverse effects MH - Incidence MH - Kidney/*drug effects/immunology/pathology MH - Male MH - Middle Aged MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - Severity of Illness Index MH - Time Factors MH - Treatment Outcome OTO - NOTNLM OT - Acute kidney injury OT - Adverse renal events OT - Checkpoint inhibitors OT - IRAEs COIS- Conflicts of Interest Statement All the authors have no conflict of interest to disclose. EDAT- 2021/02/20 06:00 MHDA- 2021/10/05 06:00 CRDT- 2021/02/19 20:12 PHST- 2020/10/08 00:00 [received] PHST- 2021/01/08 00:00 [revised] PHST- 2021/01/12 00:00 [accepted] PHST- 2021/02/20 06:00 [pubmed] PHST- 2021/10/05 06:00 [medline] PHST- 2021/02/19 20:12 [entrez] AID - S0959-8049(21)00015-0 [pii] AID - 10.1016/j.ejca.2021.01.005 [doi] PST - ppublish SO - Eur J Cancer. 2021 Apr;147:29-39. doi: 10.1016/j.ejca.2021.01.005. Epub 2021 Feb 16.