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Stein C, Burtey S, Mancini J, Pelletier M, Sallée M, Brunet P, Berbis P, Grob JJ, Honoré S, Gaudy C, Jourde-Chiche N. Acute kidney injury in patients treated with anti-programmed death receptor-1 for advanced melanoma: a real-life study in a single-centre cohort. Nephrol Dial Transplant 2020; 36:1664-1674. [PMID: 32941608 DOI: 10.1093/ndt/gfaa137] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Immune checkpoints inhibitors have transformed the prognosis of advanced melanoma but are associated with immune-related adverse events (irAEs). We evaluated the incidence, risk factors and causes of acute kidney injury (AKI) in a monocentric real-life cohort of patients treated with anti-programmed death receptor-1 (anti-PD1) antibodies for advanced melanoma. METHODS Retrospective collection of medical charts and comprehensive analysis of lab results from patients treated with nivolumab or pembrolizumab for advanced melanoma between 2014 and 2018 was carried out. AKI was defined by Kidney Disease Improving Global Outcomes criteria, and causes were determined by chart review. Overall survival, survival without AKI and impact of AKI on survival were analysed. Risk factors for death and for AKI were identified. RESULTS Two hundred and thirty-nine patients were included. Forty-one (17%) had at least one episode of AKI. Independent risk factors for AKI were treatment with renin-angiotensin-aldosterone system inhibitors (RAASi), pre-existing chronic kidney disease (CKD) and cumulated doses of anti-PD1. The main cause of AKI was prerenal, and only eight patients (3.3%) developed acute interstitial nephritis; 8% of patients developed CKD. The median overall survival was 13.4 months and was not affected by AKI. In multivariate analysis, the overall mortality was lower in overweight and obese patients and higher in patients treated with proton-pump inhibitors (PPI) or corticosteroids. CONCLUSIONS AKI is common in patients treated with anti-PD1 for advanced melanoma but is mostly prerenal and favoured by the use of RAASi; renal irAE is rare. PPI and corticosteroids were associated with poor survival in this population, while overweight/obesity was protective.
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Affiliation(s)
- Claire Stein
- Assistance Publique-Hôpitaux de Marseille, Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Marseille, France
| | - Stéphane Burtey
- Assistance Publique-Hôpitaux de Marseille, Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Marseille, France.,Aix-Marseille University, INSERM 1263, INRAE 1260, Centre de recherche en CardioVasculaire et Nutrition, Marseille, France
| | - Julien Mancini
- Assistance Publique-Hôpitaux de Marseille, Santé Publique, Hôpital de la Timone, Marseille, France
| | - Marion Pelletier
- Assistance Publique-Hôpitaux de Marseille, Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Marseille, France
| | - Marion Sallée
- Assistance Publique-Hôpitaux de Marseille, Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Marseille, France.,Aix-Marseille University, INSERM 1263, INRAE 1260, Centre de recherche en CardioVasculaire et Nutrition, Marseille, France
| | - Philippe Brunet
- Assistance Publique-Hôpitaux de Marseille, Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Marseille, France.,Aix-Marseille University, INSERM 1263, INRAE 1260, Centre de recherche en CardioVasculaire et Nutrition, Marseille, France
| | - Philippe Berbis
- Assistance Publique-Hôpitaux de Marseille, Centre de Dermatologie et de Vénéréologie, Hôpital Nord, Marseille, France
| | - Jean Jacques Grob
- Assistance Publique-Hôpitaux de Marseille, Centre de Dermatologie et de Vénéréologie et Cancérologie Cutanée, Hôpital de la Timone, Marseille, France
| | - Stéphane Honoré
- Assistance Publique-Hôpitaux de Marseille, Onco-Pharmacie, Hôpital de la Timone, Marseille, France
| | - Caroline Gaudy
- Assistance Publique-Hôpitaux de Marseille, Centre de Dermatologie et de Vénéréologie et Cancérologie Cutanée, Hôpital de la Timone, Marseille, France
| | - Noémie Jourde-Chiche
- Assistance Publique-Hôpitaux de Marseille, Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Marseille, France.,Aix-Marseille University, INSERM 1263, INRAE 1260, Centre de recherche en CardioVasculaire et Nutrition, Marseille, France
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