Hyponatremia and other electrolyte abnormalities in patients receiving immune checkpoint inhibitors

被引:29
|
作者
Seethapathy, Harish [1 ]
Rusibamayila, Nifasha [1 ]
Chute, Donald F. [1 ]
Lee, Meghan [2 ]
Strohbehn, Ian [2 ]
Zubiri, Leyre [3 ]
Faje, Alexander T. [4 ]
Reynolds, Kerry L. [3 ]
Jhaveri, Kenar D. [5 ]
Sise, Meghan E. [1 ]
机构
[1] Massachusetts Gen Hosp, Dept Internal Med, Div Nephrol, Boston, MA 02114 USA
[2] Massachusetts Gen Hosp, Dept Internal Med, Gastrointestinal Unit, Boston, MA 02114 USA
[3] Massachusetts Gen Hosp, Dept Internal Med, Div Hematol & Oncol, Boston, MA 02114 USA
[4] Massachusetts Gen Hosp, Dept Internal Med, Div Endocrinol, Boston, MA 02114 USA
[5] Donald & Barbara Zucker Sch Med Hofstra Northwell, Div Kidney Dis & Hypertens, Great Neck, NY USA
基金
美国国家卫生研究院;
关键词
electrolytes; hypokalemia; hypophosphatemia; hyponatremia; hypophysitis; immune checkpoint inhibitor; CELL LUNG-CANCER; ACUTE KIDNEY INJURY; PROGNOSTIC-FACTORS; DISORDERS;
D O I
10.1093/ndt/gfaa272
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
Background. Hyponatremia due to endocrinopathies such as adrenal insufficiency and hypothyroidism has been reported in patients receiving immune checkpoint inhibitors (ICIs). We determined the risk and predictors of hyponatremia and other electrolyte abnormalities in a 'real-world' sample of patients receiving ICIs to treat advanced malignancies. Methods. This was a retrospective observational study of all patients who received ICIs from a single cancer center between 2011 and 2018. Patients were followed for 12 months after initiation of ICIs or until death. Common Terminology for Cancer Adverse Events version 5.0 criteria were used to grade the severity of hyponatremia and other electrolyte abnormalities. The predictors of severe (Grade 3 or 4) hyponatremia were determined using a multivariable logistic regression model. The etiology of Grade 3 or 4 hyponatremia was determined by chart review. Results. A total of 2458 patients were included. Their average age was 64 years [standard deviation (SD) 13], 58% were male and 90% were white. In the first year after starting ICIs, 62% experienced hyponatremia (sodium <134 mEq/L) and 136 (6%) experienced severe hyponatremia (<124 mEq/L). Severe hyponatremia occurred on average 164 days (SD 100) after drug initiation. Only nine cases of severe hyponatremia were due to endocrinopathies (0.3% overall incidence). Risk factors for severe hyponatremia included ipilimumab (a cytotoxic T lymphocyte antigen-4 inhibitor) use, diuretic use and non-White race. Other severe electrolyte abnormalities were also commonly observed: severe hypokalemia (potassium <3.0 mEq/L) occurred in 6%, severe hyperkalemia (potassium >= 6.1 mEq/L) occurred in 0.6%, severe hypophosphatemia (phosphorus <2 mg/dL) occurred in 17% and severe hypocalcemia (corrected calcium <7.0 mg/dL) occurred in 0.2%. Conclusions. Hyponatremia is common in cancer patients receiving ICIs. However, endocrinopathies are an uncommon cause of severe hyponatremia.
引用
收藏
页码:2241 / 2247
页数:7
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