Prediction models and prognostic analysis of immune-related acute kidney injury in lung cancer patients

Abstract

Background: Immune checkpoint inhibitors (ICIs) are extensively utilized in lung cancer patients, with documented instances of ICIs-associated acute kidney injury (ICIs-AKI). This study aims to explore the incidence rates, clinical features, risk factors, and prognostic outcomes of ICIs-AKI, while developing a model for early recognition of ICIs-AKI. Methods: The study involved 413 adult lung cancer patients treated with ICIs at Ningbo No.2 Hospital between Sept. 1, 2021, and June 30, 2023. Patients were followed until death or Dec. 31, 2023, and categorized into ICIs-AKI or non-AKI groups. Prediction models for ICIs-AKI were developed using logistic regression and MLP neural networks. Cox proportional-hazards models assessed the association between ICIs-AKI and overall survival. Results: The study included 381 lung cancer patients receiving ICIs treatment after excluding 32 patients. ICIs-AKI occurred in 13.39% of cases, with a median onset time of [123 (63, 303)] days. Multivariable logistic analysis identified diabetes, proteinuria, extrarenal irAEs, diuretic use, and chemotherapy as significant risk factors (all P<0.05), while higher baseline eGFR levels were protective (P<0.05). Two prediction models were developed: logistic regression (AUC=0.877, sensitivity=0.922, specificity=0.726) and MLP (AUC=0.950, accuracy=0.843, precision=0.847). Survival analysis showed no difference in overall survival between ICIs-AKI and non-AKI groups (HR=1.021, 95% CI=0.629-1.659, P=0.932; adjusted HR=0.950, 95% CI=0.558-1.616, P=0.849). AKI to CKD progression incidence was 58.82%, with no significant difference in overall survival between CKD and non-CKD groups (P=0.157). Conclusion: This study offers detailed insights into ICIs-AKI, including its rate, onset timing, risk factors, and clinical features. Approximately half of the affected patients experienced spontaneous renal function recovery. Both logistic regression and MLP models effectively predicted ICIs-AKI. Importantly, neither ICIs-AKI incidence nor renal function restoration correlated with patient mortality. These findings improve understanding of ICIs-AKI and underscore the importance of early detection and management strategies.