A closer look at severe acute kidney injury: risk factors and outcomes in PD-1/PD-L1 antibody treatment from a retrospective study

Background Immune checkpoint inhibitors (ICIs) have improved cancer survival but increase the risk of adverse events, including acute kidney injury (AKI). Severe AKI, though rare, can disrupt treatment and worsen outcomes. Yet, research on risk factors for severe AKI in patients on PD-1/PD-L1 therapies is limited. This study aimed to identify these risk factors. Methods This retrospective cohort study analyzed electronic medical records from Zhejiang Provincial People’s Hospital from January 2019 to July 2023. In total, 907 patients who met the inclusion criteria, with a median age of 64 years, were included in the analysis. Least Absolute Shrinkage and Selection Operator (LASSO) and Cox regression analyses were conducted to determine independent risk factors for severe AKI. Results Severe AKI was observed in 3.2% of patients with AKI, with a significantly higher mortality rate than in non-AKI patients (20.7% vs. 4.1%) during the follow-up period. Multivariate Cox regression analysis identified elevated gamma-glutamyl transferase (hazard ratio (HR): 1.17), diuretic use (HR: 3.61), nonsteroidal anti-inflammatory drug (NSAID) use (HR: 4.58), and cytotoxic drugs (HR: 5.04) as independent risk factors for severe AKI. Only 11 patients (37.5%) with severe AKI recovered. Conclusions This study highlights the importance of monitoring these factors to reduce the risk of severe AKI in patients receiving PD-1/PD-L1 antibody therapy.