The incidence and risk factors for acute kidney injury in elderly patients treated with programmed cell death ligand-1 inhibitors

PU Shutong; WU Zhen; LIU Yang; ZHANG Yabin; CHENG Qingli; CHEN Hongyu; AO Qiangguo

doi:10.3969/j.issn.1009-0460.2025.05.009

Abstract：Objective To investigate the risk factors associated with the occurrence of acute kidney injury(AKI)in elderly patients with advanced lung cancer treated with programmed cell death ligand 1(PD-L1).Methods Elderly patients with advanced lung cancer who received≥1 PD-L1 treatment in our hospital from January 2020 to December 2022 were included,and divided into AKI and non-AKI groups according to the presence or absence of acute kidney injury(AKI)within 7 d after treatment.Patient demographic data,co-morbidities,laboratory test indices,and co-medication were collected.Logistic regression model was performed to analyze the risk factors associated with the occurrence of AKI in elderly lung cancer patients treated with PD-L1 inhibitors.Results A total of 182 elderly lung cancer patients were enrolled in this study,and a total of 28 patients(15.38%)were likely to develop PD-L1 inhibitor-associated AKI within 7 d of receiving PD-L1 inhibitor therapy.In multivariate analysis,age(HR=1.160,95%CI:1.046-1.280),fasting blood glucose(HR=2.280,95%CI:1.353-3.845),combined nonsteroidal anti-inflammatory drugs(HR=6.980,95%CI:2.061-23.639)and chemotherapeutic drugs(HR=4.970,95%CI:1.471-16.761)increased the risk of AKI,and higher estimated glomerular filtration rate(eGFR)levels reduced the risk of AKI(HR=0.920,95%CI:0.883-0.957).There was a trend toward an increased risk of AKI in patients with combined use of labeled diuretics,angiotensin receptor blockers/angiotensin-converting enzyme inhibitors(ARBs/ACEIs),and proton pump inhibitors(PPIs).Conclusion Elderly patients with advanced lung cancer treated with PD-L1 inhibitor had a higher incidence of AKI,and advanced age,hyperglycemia,and the combined use of nonsteroidal anti-inflammatory drugs and chemotherapeutic agents were the risk factors for AKI in patients treated with PD-L1 inhibitor,and a high eGFR level reduced the risk of AKI.