Desmopressin for the prevention of bleeding in percutaneous kidney biopsy: efficacy and hyponatremia

Lim, Cynthia Ciwei; Siow, Benson; Choo, Jason Chon Jun; Chawla, Mayank; Chin, Yok Mooi; Kee, Terence; Lee, Puay Hoon; Foo, Marjorie; Tan, Chieh Suai

doi:10.1007/s11255-019-02155-9

Cited by 14 publications

(32 citation statements)

References 30 publications

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“…Desmopressin has previously been associated with cases of severe hyponatremia, 6 often when patients were encouraged to drink large amounts of water post-NKB. In our study, a non–statistically significant association was found between desmopressin and hyponatremia (10% vs. 4%; P = 0.08); however, no patients had severe symptomatic hyponatremia and the average additional fall in natremia compared with patients not receiving desmopressin was −0.6 mmol/l.…”

Section: Discussionmentioning

confidence: 99%

“…4 Thus, some postulated that it lowers the bleeding risk in patients with reduced eGFR; however, only 1 randomized study 5 has suggested a beneficial effect for desmopressin before NKB in patients with eGFR $60 ml/ min per 1.73 m 2 , whereas current evidence in patients with eGFR <60 ml/min per 1.73 m 2 is conflicting. [6][7][8] The present study evaluates the use of desmopressin before NKB and its impact on bleeding and other complications, after controlling for recognized factors affecting bleeding risks, including kidney function at biopsy time. single tertiary care teaching hospital in Montreal, were considered for this retrospective cohort study.…”

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confidence: 99%

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Use of Desmopressin Prior to Kidney Biopsy in Patients With High Bleeding Risk

Leclerc

Nadeau‐Fredette

Elftouh

et al. 2020

Kidney International Reports

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Introduction: To prevent bleeding after native kidney biopsy (NKB), nephrologists often prescribe desmopressin, especially for patients with reduced estimated glomerular filtration rate (eGFR) at risk of uremia-related platelet dysfunction. However, only 1 randomized study has suggested a beneficial effect for desmopressin in patients with eGFR $60 ml/min per 1.73 m 2. This retrospective cohort study aimed to evaluate desmopressin effect on postbiopsy bleeding in all patients, regardless of eGFR and other comorbidities. Methods: In this retrospective cohort study, all adult patients who underwent an NKB from April 1, 2013, to April 30, 2018, in a tertiary hospital were identified. The association between desmopressin use and bleeding complications, including hemoglobin fall, transfusion, hematoma, symptomatic hematoma, urgent radiologic study, and hypotension, was analyzed using multivariable logistic regression models. Results: A total of 413 native kidney biopsies were studied, 79% of which were performed after receiving desmopressin. Patients receiving desmopressin had worse chronic kidney disease (eGFR 28 vs. 45 ml/min per 1.73 m 2 ; P < 0.001) and were more often hospitalized (48% vs. 32%; P ¼ 0.009). Despite higher bleeding risk, patients using desmopressin had a similar likelihood of symptomatic hematomas (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.13-1.14) and a lower need for urgent radiologic studies (OR, 0.33; 95% CI, 0.11-0.98). Conclusion: Patients at higher risk of bleeding using desmopressin before kidney biopsy had bleeding complications similar to those not using desmopressin. These results highlight potential important clinical and financial benefits of desmopressin use before kidney biopsy.

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Section: Discussionmentioning

confidence: 99%

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Use of Desmopressin Prior to Kidney Biopsy in Patients With High Bleeding Risk

Leclerc

Nadeau‐Fredette

Elftouh

et al. 2020

Kidney International Reports

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“…Similar findings were reported in study by Peters et al in which administration of desmopressin to patients with serum creatinine > 150 μmol/L decreased post biopsy complications (3.4% vs 8.4%, OR 0.39, CI 0.17–0.90) [12]. On the other hand, in the study by Lim et al, there was no difference in bleeding when desmopressin was administered to patients with serum creatinine ≥150 μmol/L (15% vs 13.3%, p = 0.60) but patients who received desmopressin had more episodes of severe hyponatremia (10.4% vs 3%, p = 0.002) [13]. Based on findings of our study and the study by Peters et al and Lim et al, a randomized controlled trial evaluating the efficacy of desmopressin for bleeding risk in patients with elevated creatinine is recommended.…”

Section: Discussionmentioning

confidence: 99%

“…However, decrease in hemoglobin > 1 g/dL post kidney biopsy may lead to unnecessary further testing (extended period of observation, more blood draws to follow hemoglobin level, ultrasound or CT scan to look for hematoma) increasing health care costs and causing emotional trauma to patients. Desmopressin has also been associated with risks such as increased thrombotic risk as well as symptomatic hyponatremia [13, 15–18]. Of note, desmopressin was previously used in non-uremic patients undergoing major cardiac surgery to decrease bleeding [19].…”

Section: Discussionmentioning

confidence: 99%

Desmopressin and bleeding risk after percutaneous kidney biopsy

Athavale

Kulkarni²,

Arslan

et al. 2019

BMC Nephrol

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BackgroundDesmopressin is used to reduce bleeding after kidney biopsy but evidence supporting its use is weak, especially in patients with elevated creatinine. The present study was undertaken to evaluate efficacy of desmopressin in reducing bleeding after percutaneous kidney biopsy.MethodsRetrospective cohort study. 269 of 322 patients undergoing percutaneous kidney biopsy between January 1, 2014 and January 31, 2018 were included. Patients had normal bleeding time, platelet count and coagulation profile. Primary outcome was defined as composite of hemoglobin drop ≥1 g/dL, hematoma on post biopsy ultrasound, gross hematuria, erythrocyte transfusion or angiography to stop bleeding. Association of desmopressin with outcomes was assessed using linear (for continuous variables) and logistic (for binary variables) regression models. Propensity score was used to minimize potential confounding.ResultsDesmopressin was administered to 100/269 (37.17%) patients. After propensity score adjustment patients who received desmopressin had increased odds of post biopsy bleeding [OR 3.88 (1.95–7.74), p < 0.001]. Creatinine at time of biopsy influenced bleeding risk; gender, emergent vs elective biopsy, obesity, AKI, diabetes, hypertension or bleeding time did not influence bleeding risk. Administration of desmopressin to patients with serum creatinine ≥1.8 mg/dL decreased bleeding risk [OR 2.11 (95% CI 0.87–5.11), p = 0.09] but increased bleeding risk when serum creatinine was < 1.8 mg/dL (OR 9.72 (95% CI 2.95–31.96), p < 0.001).ConclusionDesmopressin should not be used routinely prior to percutaneous kidney biopsy in patients at low risk for bleeding but should be reserved for patients who are at high risk for bleeding.

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