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The association between acute kidney injury and outcomes in cancer patients receiving immune checkpoint inhibitor therapy: a systematic review and meta-analysis

Publicated to:Clinical Kidney Journal. NULL- - 2022-08-31 (), DOI: 10.1093/ckj/sfac194

Authors: Kanbay, Mehmet; Copur, Sidar; Siriopol, Dimitrie; Yildiz, Abdullah Burak; Berkkan, Metehan; Popa, Raluca; Hasbal, Nuri Baris; Ortiz, Alberto; Perazella, Mark A.;

Affiliations

IIS Fdn Jimenez Diaz, Madrid, Spain - Author
Koc Univ, Dept Med, Sch Med, Istanbul, Turkey - Author
Koc Univ, Dept Med, Sect Nephrol, Sch Med, Istanbul, Turkey - Author
St John New Cty Hosp, Dept Nephrol, Suceava, Romania - Author
Univ Autonoma Madrid, Dept Med, Madrid, Spain - Author
Yale Univ, Sch Med, Dept Internal Med, Sect Nephrol, New Haven, CT 06520 USA - Author
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Abstract

Lay Summary Immune checkpoint inhibitors are a novel therapeutic approach to cancer treatment that have changed the landscape of cancer therapy but also have some considerable drawbacks. Acute kidney injury (AKI) is one of these potential complications that may have effects on patient outcomes. In this review, development of AKI in patients with cancer receiving immune checkpoint inhibitors is associated with increased risk of mortality.Background Immune checkpoint inhibitors (ICPIs) are a novel therapeutic approach to cancer treatment that have changed the landscape of cancer therapy but also have some considerable drawbacks. Acute kidney injury (AKI) is one of these potential complications that may have effects on patient outcomes. In this review, we assessed the effect of AKI on mortality outcomes in cancer patients receiving this immunotherapy. Methods We performed a systematic review and meta-analysis of prospective, retrospective, randomized and non-randomized studies, which examined the effects of AKI in cancer patients receiving immune checkpoint inhibitors. We searched through PubMed, Medline, Web of Science, Scopus and Cochrane Library databases. Results Seven studies were included in the final analysis, with a total number of patients of 761. Overall, the risk of death was higher in patients that developed AKI during ICPI treatment [hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.05-1.92, P = 0.02; heterogeneity chi(2) = 11.68, I-2 = 66%, P = 0.02] compared with patients that did not develop AKI. In addition, there was a trend to a better survival in those with less severe AKI patients compared with those with more severe AKI (HR 1.35, 95% CI 0.99-1.83, P = 0.05). Lastly, it was seen that patients with persistent kidney dysfunction (non-recovery) had an increased risk for all-cause mortality (HR 2.93, 95% CI 1.41-6.08, P = 0.004; heterogeneity chi(2) = 0.53, I-2 = 0%, P = 0.47). Conclusions Development of AKI in patients with cancer receiving immune checkpoint inhibitors is associated with increased risk of mortality.

Keywords
Acute interstitial nephritisAcute kidney injuryAcute renal failureFeaturesImmune checkpoint inhibitorsImmunotherapyNephrotoxicity

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Clinical Kidney Journal due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position 17/88, thus managing to position itself as a Q1 (Primer Cuartil), in the category Urology & Nephrology.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 5.61, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions May 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-05-25, the following number of citations:

  • WoS: 2
  • Scopus: 12
  • OpenCitations: 6
Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-05-25:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 13.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 12 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 30.2.
  • The number of mentions on the social network X (formerly Twitter): 29 (Altmetric).
Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Oman; Turkey; United States of America.