Acute Kidney Injury Following Chimeric Antigen Receptor T-Cell Therapy: A Retrospective Cohort Analysis

Background: Chimeric antigen receptor T-cell (CAR-T) therapy is associated with numerous adverse effects, among which acute kidney injury (AKI) remains poorly characterized. This study aimed to determine the incidence and risk factors of AKI following CAR-T therapy. Methods: This retrospective study was conducted among adult patients who received CAR-T cell therapy at an university hospital between April 2019 and December 2023. The incidence and risk factors for AKI, as well as its impact on overall survival and progression-free survival, were analyzed using univariate and multivariate analyses. Results: A total of 220 patients were included (mean age 63 ± 12 years), mostly treated for B-cell lymphomas. Pre-existing chronic kidney disease (CKD) was present in 26% of patients, and 24% had been admitted to the intensive care unit. The cumulative incidence of AKI was 20.5% (n = 45), occurring early after CAR-T infusion (4 days). Among AKI cases, 22% were KDIGO stage 3, and 15.6% required renal replacement therapy. In multivariate analysis, pre-existing CKD was strongly associated with AKI occurrence (adjusted OR 8.9), as was exposure to ACEI and ARBs with nephrotoxic agents (adjusted OR 2.7). Severity of cytokine release syndrome, and CAR-T–associated encephalopathy were associated with AKI in univariate analysis. Severe AKI was associated with reduced progression-free survival. Conclusions: Acute kidney injury commonly occurs following CAR-T cell therapy, and its occurrence was closely linked to pre-existing renal comorbidities and cumulative exposure to nephrotoxic agents and ACEI and ARBS. The severity of AKI was associated with reduced overall survival and progression-free survival.