Introduction: Immune checkpoint inhibitors (ICIs) are monoclonal antibodies that target inhibitory receptors expressed on T cells and are associated with a variety of immune-related adverse events (irAE) including the kidneys. This study attempted to determine the factors, incidence, electrolyte and urine abnormalities, clinical outcomes, and development of chronic kidney disease (CKD) among patients who developed immune checkpoint inhibitor-associated acute kidney injury (ICI AKI).

Methodology: Single-center retrospective cohort study of cancer patients receiving ICI between January 2018 and December 2024 at St. Luke's Medical Center Quezon City, Philippines. To be included, patients must have cancer, at least 18 years old, and had to receive ≥ 1 dose of ICI. They were excluded if they are already on renal replacement therapy (RRT), no baseline serum creatinine (sCr) prior to giving the first dose of ICI, or sCr after the 1st dose or ≥ 3 months after administration of ICI.

Results: Among the 210 patients treated with ICI, 8 (3.8%) developed ICI AKI. Among the patients treated with ICI, a total of 14.29% (30) patients developed AKI. Among those who developed AKI, 53.33% (16) of patients progressed to chronic kidney disease and in patients who developed ICI AKI, 37.5% progressed to CKD. Urinalysis also showed that 39.52% (83) of patients had hematuria and 44.76% (94) had proteinuria. Moreover, 34.3% (72) of patients had electrolyte abnormalities with the most common electrolyte abnormality being hyponatremia at 25.7%.

Conclusion and Recommendation: This study showed that the incidence of ICI AKI was at 3.8%. The most common electrolyte abnormality was hyponatremia and among patients who developed ICI AKI, 37.5% progressed to CKD. No statistically significant risk factor was associated with the development of ICI-AKI. However, interpretation of these findings should be approached with caution given the small number of ICI-AKI events (n = 8), which limited the statistical power of the analysis and resulted in wide confidence intervals for several estimates. A prospective multicenter cohort study may be done in the future.

Keywords: Immune checkpoint inhibitor associated acute kidney injury, acute kidney injury, chronic kidney disease

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