Abstract / Summary
Abstract Immune checkpoint inhibitor-associated acute kidney injury (ICI-AKI) is an increasingly recognized complication of cancer immunotherapy, yet its clinical heterogeneity and limited predictors pose challenges for early identification. This study aimed to characterize ICI-AKI, identify associated factors, and develop an exploratory nomogram for risk assessment. In this single-center retrospective study, 181 adults receiving ICIs at Huashan Hospital, Fudan University, between 2023 and 2025 were included, comprising 84 patients with adjudicated ICI-AKI and 97 controls without AKI during at least 6 months of follow-up. Clinical characteristics, pathological findings, treatment patterns, and kidney outcomes were evaluated. Univariable and multivariable logistic regression analyses were performed, and nomogram performance was assessed using receiver operating characteristic analysis, bootstrap internal validation, calibration analysis, and decision curve analysis. The median time from ICI initiation to AKI onset was 84 days, and most affected patients presented with stage 2 or 3 AKI. Acute tubulointerstitial nephritis (ATIN) was the most common pathological finding among the 24 biopsied patients. Multisystem complications during ICI therapy (OR, 4.552; 95% CI, 1.554–13.335), lower baseline estimated glomerular filtration rate (OR, 0.878; 95% CI, 0.827–0.933), higher baseline myoglobin (OR, 1.021; 95% CI, 1.001–1.042), and longer baseline prothrombin time (OR, 2.566; 95% CI, 1.452–4.536) were independently associated with ICI-AKI. The nomogram incorporating these variables demonstrated good discrimination, with an area under the curve (AUC) of 0.888 (95% CI, 0.837–0.939), and favorable internal calibration. These findings identify clinical and laboratory features associated with ICI-AKI and support their further investigation for risk assessment during ICI therapy.