Exploring the knowledge gap of immune checkpoint inhibitors in chronic renal failure: A systematic review of the literature

•The safety and efficacy of immune checkpoint inhibitors (ICI) in chronic kidney disease (CKD) patients is not well established.•ICI appear to be safe without the need for dose adjustment in advanced CKD and dialysis patients, but large confirmatory studies are needed.•Among 60 kidney gaft recipients with cancer treated with ICI, 55 % had a progressive disease under treatment and 45 % had an episode of rejection.•Kidney transplant recipients can profit the most from ICI treatment if combined with mTOR inhibitor-based immunosuppression protocols. Targeting the immune system with immune checkpoint inhibitors (ICI) to treat cancer has been lately adopted with a significant improvement of patients’ survival. In parallel, the incidence of malignancy in chronic kidney disease (CKD) patients is increasing, but solid evidence concerning the efficacy and safety of ICI in this population is lacking. Moreover, the use of these agents as immunity boosters in kidney graft recipients treated with immunosuppressors is still controversial. We present in this article a review of the pharmacological properties of these drugs and their behavior with kidney failure and dialysis, as well as evidence of their use in different populations of CKD. Most of the available data are limited to case reports and case series. These drugs appear to be safe without dose adjustment in CKD patients and patients on dialysis. A major concern with this therapy in transplanted patients remains the risk of graft rejection.