Early Acute Kidney Injury and Its Association With Survival in Patients With Metastatic Non-Small-Cell Lung Cancer Treated With Front-Line Immunotherapy-Based Therapies

Abstract

Introduction: Immune checkpoint inhibitors (ICIs) have revolutionized metastatic NSCLC treatment. Acute kidney injury (AKI) is a common complication of ICI-based therapies, alone or with chemotherapy. This study investigates the association between early AKI and 12-month survival among patients with metastatic NSCLC receiving front-line ICI-based treatment. Methods: This retrospective study included metastatic NSCLC patients who received ICI-based therapy (2017–2022). Early AKI was defined as a creatinine increase ≥ 1.5 times baseline within 21 days of the fourth cycle or last cycle if fewer than four were given. Clinical characteristics were compared using t-tests and chi-squared tests. Survival differences were assessed by Kaplan–Meier and log-rank tests, with Cox models evaluating the association between AKI and 12-month survival. Results: Of the 310 patients, AKI occurred in 38 patients (12.6%), with 8 patients (2.3%) missing follow-up creatinine data. The hazard ratio (HR) for death within 12 months for patients who developed early AKI was 1.733 (95% CI 1.060–2.835, p = 0.026). The highest rate of early AKI was seen in patients receiving pemetrexed, pembrolizumab, and carboplatin (16.7%), compared to 11.1% for pembrolizumab monotherapy and 4.5% for pembrolizumab with paclitaxel and carboplatin. Although patients who recovered renal function were more likely to continue immunotherapy, 12-month survival rates did not significantly differ (52.2% vs. 46.7%). Conclusions: Early AKI during pembrolizumab-based treatment in metastatic NSCLC patients was associated with reduced 12-month survival. These findings highlight the need for close monitoring and preventive strategies to manage AKI in this population.