#1085 Acute kidney injury in Iraqi cancer patients treated with immune checkpoint inhibitors. (project ICI-AKI Iraq) interim analysis

Abstract Background and Aims Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment and are now the backbone of therapy for several malignancies. However, the trade-off is the occurrence of Immune-Related Adverse Events (irAEs). ICIs can cause a spectrum of renal irAEs, including acute kidney injury (AKI), most commonly manifesting as acute interstitial nephritis (AIN). In a recent meta-analysis of eighteen studies, ICI-AKI incidence was 16%. Here, we present a six-month interim analysis of a one-year project (ICI-AKI Iraq). The objective is to define the incidence of AKI in Iraqi cancer patients treated with ICIs and any related risk factors. Method The study employs a cross-sectional design with a prospective analytical component. From June 1, 2024, patients were recruited and followed up for six months at the Oncology Hospital and the Nephrology and Renal Transplantation Centre in Baghdad. Patients with ESKD or transplant recipients or those who were unwilling to participate were excluded. Patients who commenced therapy six months before the study were also evaluated under a retrospective arm, but any patient who previously had a diagnosis of ICI-AKI was excluded. All the medical, oncology, and pharmaceutical data were recorded and analyzed. The study's outcome is to define the incidence of AKI according to the KDIGO criteria. The project was conducted according to the National Research Ethics Code, and the patient consented to the study before enrollment. The project completion will be in June 2025. Results A total of 185 cancer patients have been recruited for the study till now. The mean age of the study group is 55.5 + 15 years, with 108 males (58%). Among these patients, 35 individuals (19%) were diagnosed with chronic kidney disease (CKD) in Stages II, III, and IV. At baseline, the mean serum creatinine level of the study group was 1 + 0.37 mg/dl. AKI was confirmed in 26 patients (14%). Four patients were in KDIGO-AKI stage II, while the other 22 patients were in KDIGO-AKI stage I. The mean time for occurrence of AKI is 119 + 80 days. At six months, two patients had a persistent low eGFR, CKD stage III. At all time points (C1 to C6), the creatinine was statistically significantly higher for the AKI groups than the non-AKI group (p-value <0.05). The correlation between AKI risk and age, sex, cancer diagnosis, or baseline chemotherapy didn't reach statistical significance. Conclusion With this six-month interim analysis, the incidence of AKI in Iraqi cancer patients treated with ICIs is 14%. Further evaluation will elucidate the one-year incidence and related risk factors. Patients who start immunotherapy with ICIs merit close monitoring of kidney function and vigilance to detect AKI.