The Incidence, Severity and Risk Factors of Renal Injury in Lung Cancer Patients Receiving Osimertinib Therapy: A Real-World Study.

AIM: The high burden of lung cancer in developing countries has led to the widespread use of EGFR inhibitors like osimertinib. However, little is known about the prevalence and risk factors of renal injury associated with osimertinib use. Therefore, this study aims to investigate the incidence, severity and risk factors of renal injury in patients receiving osimertinib in the real world. METHODS: We retrospectively analyzed 1138 patients with lung cancer treated with osimertinib. Renal injury was defined as an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73m2 and/or the presence of proteinuria. Multivariable logistic regression models were used to identify independent risk factors for renal injury. RESULTS: Totally, 215 (18.89%) patients developed renal injury during follow-up. Most cases of renal injury were transient (149/1138, 13.09%), while sustained renal injury accounted for 5.8% (66/1138) of the total cohort. Impaired renal function (eGFR < 60 mL/min/1.73m2) was observed in 136 (11.95%) patients, predominantly at a moderate stage (eGFR 30-59), and proteinuria was present in 100 (8.79%) patients, primarily of mild severity. Among patients with renal injury, 73.53% had a mild creatinine elevation (< 50% increase from baseline). Moreover, the mean time to renal injury onset was 7.92 months (SD 8.34), with a mean recovery time of 4.21 months (SD 6.31). Importantly, age ≥ 60 years (OR = 2.307, 95% CI: 1.348-3.947, p = 0.002) and baseline renal injury (OR = 20.942, 95% CI: 8.398-52.223, p < 0.001) were significant independent risk factors for sustained renal injury. CONCLUSIONS: This study demonstrates that renal injury is not rare in lung cancer patients treated with osimertinib, particularly in patients aged ≥ 60 years or with pre-existing renal injury. Although most cases are reversible, regular monitoring of renal function is strongly recommended for these patients.