Prediction Models and Prognostic Analysis of Immune-Related Acute Kidney Injury in Lung Cancer Patients

IntroductionImmune checkpoint inhibitors (ICIs) are extensively utilized in lung cancer patients, with documented instances of ICIs-associated acute kidney injury (ICIs-AKI). This study aims to explore a model for early recognition of ICIs-AKI.MethodsThe study involved 413 adult lung cancer patients treated with ICIs at Ningbo No.2 Hospital between Sept. 1, 2021, and June 30, 2023. Patients were followed until death or Dec. 31, 2023, and categorized into ICIs-AKI or non-AKI groups. We employed univariate and multivariate logistic regression to identify risk factors, developed both logistic regression and Multilayer Perceptron (MLP) prediction models, and used Kaplan-Meier survival analysis to assess prognosis.ResultsThe study included 381 lung cancer patients receiving ICIs treatment after excluding 32 patients. ICIs-AKI occurred in 13.39% of cases, with a median onset time of [123 (63, 303)] days. Multivariable logistic analysis identified diabetes, proteinuria, extrarenal irAEs, diuretic use, and chemotherapy as significant risk factors (all P < 0.05), while higher baseline eGFR levels were protective (P < 0.05). Two prediction models were developed: logistic regression (AUC=0.877, sensitivity=0.922, specificity=0.726) and MLP (AUC=0.950, accuracy=0.843, precision=0.847). Survival analysis showed no difference in overall survival between ICIs-AKI and non-AKI groups (HR = 1.021, 95% CI = 0.629-1.659, P = 0.932; adjusted HR = 0.950, 95% CI = 0.558-1.616, P = 0.849). AKI to CKD progression incidence was 58.82%, with no significant difference in overall survival between CKD and non-CKD groups (P = 0.157).ConclusionThis study offers detailed insights into ICIs-AKI, including its rate, onset timing, risk factors, and clinical features. Approximately half of the affected patients experienced spontaneous renal function recovery. Both logistic regression and MLP models effectively predicted ICIs-AKI. Importantly, neither ICIs-AKI incidence nor renal function restoration correlated with patient mortality. These findings underscore the importance of early detection and management strategies.