Practice patterns and outcomes in cancer patients developing immune checkpoint inhibitors–related AKI

Q: How was AKI defined and measured in this study?

AKI was defined using an increase in serum creatinine and graded by event severity. The analysis estimated cumulative incidence during ICI and non-ICI systemic therapy periods in Ontario, Canada (2012–2018).

Q: What were the overall incidence rates of AKI among ICI-treated patients?

Among patients receiving ICI therapy (n=4,380), the crude 4-year incidence of AKI was 29% for any stage, and severe AKI (stage ≥2) was 7%.

Q: What did the study find regarding AKI risk with ICI versus non-ICI therapy?

The risk of experiencing AKI was significantly lower with ICI versus non-ICI systemic therapy (adjusted hazard ratio 0.80, 95% CI 0.74–0.86, P-value < .0001).

Q: What happened when patients stopped ICI therapy after AKI?

Among 587 patients who had AKI and were alive and discontinued ICI within 30 days, 9% were re-challenged with ICI within the following 6 months, and 44% of those re-challenged experienced recurrent AKI.

Sep 23, 2026

Uploaded by Riley West

Acute kidney injury (AKI) represents a recognized immune-related adverse event of cancer immune checkpoint inhibitor (ICI) therapy, yet population-level evidence on incidence, risk factors, and post-ICI practice patterns remains limited. In Ontario, Canada (2012–2018), cumulative AKI incidence was measured among advanced cancer patients receiving ICI versus non-ICI systemic therapy. Among 16,425 patients (4,380 on ICI), crude 4-year AKI was 29% (any stage) and 7% for severe AKI (stage ≥2). AKI risk was higher with male sex, genitourinary malignancy, hypertension, diabetes, chronic kidney disease, and NSAID use, while ICI exposure showed a lower adjusted AKI risk (aHR 0.80).

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Keywords

Nephrol Dial Transplant, 2026, 41, 657–668 [https://doi.org/10.1093/ndt/gfaf191](https://doi.org/10.1093/ndt/gfaf191) Advance access publication date: 27 September 2025 Practice patterns and outcomes in cancer patients developing immune checkpoint inhibitors–related AKI Phillip S. Blanchette 1 ,2 ,3 , Jennifer Reid1 , Lucie Richard 1 ,10 , Salimah Z. Shariff1 ,4 , Jacques Raphael 1 ,2 ,3 , Craig C. Earle5 ,6 , Amit X. Garg1 ,2 ,7 and Abhijat Kitchlu 8 ,9 1 ICES Western, London Health Sciences Centre Research Institute, London Health Sciences Centre, London, Ontario, Canada 2 London Health Sciences Centre, London, Ontario, Canada 3 Division of Medical Oncology, Department of Oncology, Verspeeten Family Cancer Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada 4Arthur Labatt Family School of Nursing, Western University, London, Canada 5 Sunnybrook Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada 6 Division of Medical Oncology Department of Medicine, University of Toronto, Ontario, Canada 7 Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada 8University Health Network, Toronto, Ontario, Canada 9 Division of Nephrology, Department of Medicine University of Toronto, Toronto, Ontario, Canada 10 Current affiliation: MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada Correspondence to: Phillip Blanchette; [E-mail:](E-mail: phillip.blanchette@lhsc.on.ca)[ phillip.blanchette@lhsc.on.ca](E-mail: phillip.blanchette@lhsc.on.ca) Watch the video of this contribution at [https://academic.oup.com/ndt/pages/author_videos](https://academic.oup.com/ndt/pages/author_videos) ABSTRACT Background. Acute kidney injury (AKI) is a known immune-related adverse event of cancer immune checkpoint inhibitor (ICI) therapy. Further population-based data on AKI incidence, risk factors and practice patterns post-ICI therapy are needed. Methods. We measured the cumulative incidence of AKI among advanced cancer patients while receiving ICI therapy and non-ICI systemic therapy in Ontario, Canada (2012–18). An increase in serum creatinine was used to define AKI and graded according to event severity. Time to event modeling was used to compare the risk of developing AKI, pre-disposing factors and survival outcomes. Results. We studied 16 425 patients with advanced cancer receiving either ICI or non-ICI systemic therapy. Among 4380 patients receiving ICI therapy, the overall crude 4-year incidence of AKI (any stage) was 29% and severe AKI (stage ≥2) was 7% . Characteristics associated with a higher risk ofAKI included male sex, genitourinary (versus other) malignancy, the presence of hypertension, diabetes or chronic kidney disease, and prescription of a non-steroidal anti-inflammatory drug. The risk of experiencing AKI was significantly lower among patients treated with ICI versus non-ICI systemic therapy [adjusted hazards ratio (aHR) 0.80, 95% confidence interval (CI) 0.74–0.86, P-value <.0001]. Among the 587 patients who experienced an AKI and were both alive and discontinued ICI therapy within 30 days, 54 (9%) were re-challenged with ICI in the following 6 months and 24 (44%) had a recurrent AKI event. Patients who were re-challenged with ICI therapy had improved overall survival as compared with patients that received other non-ICI systemic therapy (aHR 0.38, 95% CI 0.22–0.67, P-value <.001) . Conclusion. Our real-world study demonstrates a modest risk for severe AKI among cancer patients receiving ICI therapy, lower than with exposure to other systemic cancer therapies. Among patients who developed AKI and stopped ICI therapy, re-challenge was uncommon but may warrant consideration for select patients. Keywords: acute kidney injury, cancer, immune checkpoint inhibitor Received: March 17, 2025 . Accepted: August 20, 2025 © The

FAQs

How was AKI defined and measured in this study?

AKI was defined using an increase in serum creatinine and graded by event severity. The analysis estimated cumulative incidence during ICI and non-ICI systemic therapy periods in Ontario, Canada (2012–2018).

What were the overall incidence rates of AKI among ICI-treated patients?

Among patients receiving ICI therapy (n=4,380), the crude 4-year incidence of AKI was 29% for any stage, and severe AKI (stage ≥2) was 7%.

What did the study find regarding AKI risk with ICI versus non-ICI therapy?

The risk of experiencing AKI was significantly lower with ICI versus non-ICI systemic therapy (adjusted hazard ratio 0.80, 95% CI 0.74–0.86, P-value < .0001).

What happened when patients stopped ICI therapy after AKI?

Among 587 patients who had AKI and were alive and discontinued ICI within 30 days, 9% were re-challenged with ICI within the following 6 months, and 44% of those re-challenged experienced recurrent AKI.

Sep 23, 2026

Uploaded by Riley West