Clinical factors associated with acute kidney injury following CAR-T cell therapy: a systematic review and meta-analysis

Acute kidney injury (AKI) is an increasingly recognized but still underappreciated complication of chimeric antigen receptor T-cell (CAR-T) therapy. Several clinical factors may contribute to its development; however, these risk factors have not been comprehensively evaluated. This meta-analysis aimed to systematically identify factors associated with AKI in patients undergoing CAR-T therapy. A systematic search of PubMed, EMBASE, and the Cochrane Library was conducted to identify relevant studies published up to April 1, 2026. The exposures of interest included sex, cytokine release syndrome (CRS; any grade), severe CRS (grade ≥ 3), immune effector cell-associated neurotoxicity syndrome (ICANS; any grade), and severe ICANS (grade ≥ 3). Study quality was assessed using the Newcastle–Ottawa Scale. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. A total of 411 records were identified, and 6 cohort studies published between 2022 and 2024 were included. These studies were conducted in China, France, Italy, and the United States, with sample sizes ranging from 34 to 166 patients. All studies defined AKI according to KDIGO criteria and were rated as high quality. The pooled analysis showed that male sex was not significantly associated with AKI risk (OR = 1.27, 95% CI 0.77–2.10, I 2 = 0%). Similarly, CRS and ICANS at any grade were not significantly associated with AKI (CRS: OR = 2.92, 95% CI 0.48–17.91, I 2 = 71.7%; ICANS: OR = 1.31, 95% CI 0.74–2.32, I 2 = 0%). In contrast, severe CRS was significantly associated with an increased risk of AKI (OR = 5.62), whereas severe ICANS was modestly associated with AKI (OR = 1.88), with low heterogeneity. Severe CRS and severe ICANS are important predictors of AKI following CAR-T therapy. Early identification and appropriate management of severe toxicities may help reduce AKI incidence and improve patient outcomes.