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Background Immunotherapy has transformed cancer treatment across a wide range of malignancies. However, patients with chronic kidney disease (CKD)—especially those with advanced disease—remain understudied due to frequent exclusion from clinical research. 1 2 Despite this, immunotherapy is administered during hospitalizations in real-world settings, including among patients with CKD. This study evaluates the impact of CKD severity on length of stay (LOS), hospital charges, and inpatient mortality in hospitalized adults receiving immunotherapy.Methods We analyzed the National Inpatient Sample (NIS) from 2016 to 2020 to identify adult hospitalizations with a primary procedure code for immunotherapy. CKD was identified using ICD-10 codes and categorized as mild to moderate (stages 1–3) or severe (stages 4–5). Outcomes included LOS, total hospital charges (THC), and inpatient mortality. Comparisons used t-tests and chi-square tests. Multivariable logistic regression adjusted for age, sex, race, insurance, and household income.Results Among 25,830 hospitalizations involving immunotherapy, 1,040 (4%) had CKD, including 190 (18%) with severe disease. CKD patients were older (mean age 61.6 vs. 42.8 years, p<0.001), more often male (65.3%, p=0.06), and predominantly White (70.7%, p=0.1). Over half had Medicare insurance (54.9%, p<0.001). No in-hospital mortality was reported among CKD patients, compared to 0.8% in the overall cohort (not significant). Mean LOS was 6.7 days overall, 6.7 for mild to moderate CKD, and 5.9 for severe CKD. Mean THC was $219,493 overall, $235,457 for mild to moderate CKD, and $367,141 for severe CKD. No significant differences in LOS or THC were observed between CKD and non-CKD groups or between severity subgroups.Conclusions Patients with CKD, including those with advanced stages, represent a measurable portion of hospitalized immunotherapy recipients but remain undercharacterized in the literature. In this national cohort, CKD was not associated with increased inpatient mortality, LOS, or hospital charges. These findings highlight the need for further research to better understand immunotherapy outcomes in patients with underlying kidney disease.References Elyan BMP, Kitchlu A, Hall S, et al. Kidney disease patient representation in trials of cancer immunotherapy. Kidney Med. 2023;5(8):100709. doi:10.1016/j.xkme.2023.100709Tiu BC, Khakwani A, Sampuj S, et al. Safety of immune checkpoint inhibitors in patients with advanced chronic kidney disease. Oncologist. 2023;28(6):e379–e386. doi:10.1093/oncolo/oyad066