Immune checkpoint inhibitors-associated acute kidney injury: a systematic review and meta-analysis of incidence, kidney recovery, and recurrent risk

BACKGROUND: Immune checkpoint inhibitors (ICIs) are widely used in cancer therapy but can cause adverse events, including acute kidney injury (AKI). The incidence of ICI-associated AKI (ICI-AKI) varies across studies, and while steroids may aid in kidney recovery, their full effects require further investigation. Additionally, the risk of recurrent AKI with ICI rechallenge remains uncertain. This study assesses the incidence of ICI-AKI, evaluates steroid efficacy, and examines the risk of recurrent AKI after ICI-AKI. METHODS: A comprehensive search of PubMed, Embase, and the Cochrane Library was conducted through May 2024. Outcomes included the incidence of ICI-AKI, kidney recovery after steroid therapy, and the risk of recurrent AKI with ICI rechallenge. A random-control model was used for analysis. RESULTS: This analysis included 16 studies involving 10,726 participants. The pooled incidence of ICI-AKI after following up for one year was 1.4% (95% CI 1.0-2.1%), with the incidence rate being 4.3 per 100 patient-years (95% CI 2.3-6.3 per 100 patient-years). ICI-AKI patients treated with steroid were more likely to achieve kidney recovery (OR 1.82, 95% CI 1.17-2.83, P = 0.008). No additional benefit was found from combining intravenous and oral steroids (OR 0.928, P = 0.863). The incidence of recurrent AKI after ICI-AKI was 18.0% (95% CI 13.2-23.9%). CONCLUSIONS: A substantial incidence of ICI-AKI of those receiving ICI was identified. Steroid treatment promotes kidney recovery, but adding intravenous steroids offers no additional benefit. There is an elevated risk of recurrent AKI with ICI rechallenge, underscoring the need for careful monitoring of kidney function.