Background: Immune checkpoint inhibitors (ICIs) have significantly modified the management of metastatic cancers; however, their nephrotoxic potential remains underappreciated. While acute kidney injury (AKI) is a known immune-related adverse event, the subacute spectrum of kidney injury—termed acute kidney disease (AKD)—has not been adequately explored in this setting. Methods: We conducted a retrospective cohort study in 226 adult patients with metastatic solid tumors who received ICIs between 2017 and 2023 at a single tertiary care center. AKD was defined according to the 2024 “Kidney Disease: Improving Global Outcomes” (KDIGO) criteria. Multivariable logistic regression was used to identify predictors of AKD. Results: AKD occurred in 46 patients (20.4%) within 90 days of ICI initiation, with 16 (7.1%) experiencing persistent dysfunction beyond 30 days. Independent predictors of AKD included higher body surface area (OR 8.17,p= 0.03) and baseline use of nonsteroidal anti-inflammatory drugs (OR 29.74,p= 0.014). Baseline antibiotics showed a trend toward association (p= 0.054). Concurrent chemotherapy was associated with a trend toward protection. The predictive model showed good discrimination (AUC 0.778). No significant differences in other grade ≥2 immune-related adverse events were observed between the AKD and non-AKD groups. Conclusions: AKD is a frequent and underrecognized renal complication in patients receiving ICIs, with implications for both renal and oncological outcomes. Identifying high-risk patients and integrating longitudinal renal monitoring into immunotherapy care pathways may improve safety and treatment continuity.
背景：免疫检查点抑制剂（ICIs）已显著改变了转移性癌症的治疗策略，但其潜在的肾毒性尚未得到充分认识。尽管急性肾损伤（AKI）是已知的免疫相关不良事件，但在此背景下，亚急性肾损伤谱——即急性肾脏病（AKD）——尚未得到充分探讨。方法：我们对2017年至2023年间在一家三级医疗中心接受ICIs治疗的226例转移性实体瘤成年患者进行了回顾性队列研究。AKD根据2024年《肾脏病：改善全球预后》（KDIGO）标准进行定义。采用多变量逻辑回归分析确定AKD的预测因素。结果：在ICI启动后90天内，46例患者（20.4%）发生AKD，其中16例（7.1%）肾功能障碍持续超过30天。AKD的独立预测因素包括较高的体表面积（OR 8.17，p=0.03）和基线期使用非甾体抗炎药（OR 29.74，p=0.014）。基线期抗生素使用显示出关联趋势（p=0.054）。联合化疗则显示出保护性趋势。预测模型显示出良好的区分度（AUC 0.778）。AKD组与非AKD组在其他≥2级免疫相关不良事件方面未观察到显著差异。结论：AKD是接受ICIs治疗患者中常见且未被充分认识的肾脏并发症，对肾脏及肿瘤预后均具有重要影响。识别高危患者并将纵向肾功能监测纳入免疫治疗护理路径，可能有助于提升治疗安全性和连续性。
肿瘤(癌症)患者之家