Kidney Week

Abstract: FR-PO200

Hidden Kidney Impact of Immunotherapy in Patients with Metastatic Kidney and Bladder Cancer: "Nothing Is What It Seems"

Session Information

• Onconephrology: Immunotherapy Nephrotoxicity and Assessment of GFR
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Onconephrology

• 1700 Onconephrology

Authors

• Trevisani, Francesco, IRCCS Ospedale San Raffaele, Milano, Italy

Francesco Trevisani, MD, PhD

• Angioi, Andrea, Azienda Ospedaliera Brotzu, Cagliari, Italy

Andrea Angioi, MD, FASN

• Floris, Matteo, Azienda Ospedaliera Brotzu, Cagliari, Italy

Matteo Floris, MD

• Simeoni, Mariadelina, Universita degli Studi della Campania Luigi Vanvitelli, Caserta, Italy

Mariadelina Simeoni, MD, PhD, APN

• Galassi, Barbara, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy

Barbara Galassi

• Ruatta, Fiorella, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy

Fiorella Ruatta, MEd

• Garrone, Ornella, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy

Ornella Garrone, MD

• Ghidini, Michele, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Lombardia, Italy

Michele Ghidini, MD, PhD

Background

Immunotherapy has emerged as a pivotal treatment for metastatic renal and bladder cancer. Hovewer, its impact on renal function in term of Acute Kidney Disease (AKD), remains a critical concern. In addiction, the role of nephrologist in this asset of patients remains ancillary and only related to AKI events.
Therefore, our aim was to elucidate the incidence and persistence of the insidious and dangerous AKD condition in a cohort of 33 consecutive urological metastatic pts subjected to immunotherapy.

Methods

We conducted a retrospective analysis of 33 patients receiving first-line immunotherapy for metastatic renal and bladder cancer. Patient demographics, clinical characteristics, and treatment details were extracted. Labs were done monthly and kidney function was assessed with eGFR (CKD-EPI 2021; Janowitz formula). AKD was defined as an increase in serum creatinine by ≥0.3 mg/dL or an increase to ≥1.5 times the baseline, persisting for ≥7 days post-exposure and < 3 months in line with K-DIGO 2023 guidelines.

Results

Descriptive analysis is shown in table 1.
The incidence of AKD in 6 months of treatment was 24.24%, observed in 8 patients; among these, 6.06% (2 patients) exhibited persistence of AKD over three consecutive months, which was significant at Fisher’s test (p=0.05). The slope of eGFR from baseline to six months showed that most patients had minimal changes in kidney function, with a mean slope of 0.634 mL/min/1.73m² per month (Figures 1a, 2a,1b,2b). Notably, some patients experienced significant declines, with slopes as steep as -40 mL/min/1.73m² per month.

Conclusion

This innovative study highlights for the first time a significant and unexpected incidence (24%) of AKD in patients treated with immunotherapy for metastatic renal and bladder cancer. Because AKD can often evolve in CKD, an onco-nephrological counseling able to reduce the incidence of AKD is mandatory