Hyponatremia may be an under‐recognized complication after desmopressin to reduce uremic bleeding in kidney biopsy

Abstract

read with interest the observational study by Peters et al. that found reduced minor and major complications after kidney biopsy among patients with serum creatinine ≥150 μmol/L. 1 The authors noted absence of negative sideeffects in their study but acknowledged that electrolyte derangements were not specifically examined. Based on a historical study of 269 transplant allograft biopsies where all received pre-biopsy desmopressin and none had symptomatic hyponatremia, 2 the authors opined that hyponatremia after a single dose of desmopressin was uncommon. However, the low incidence of desmopressin-induced hyponatremia in that study may be due to patients being administered only four 'units' of desmopressin before biopsy. 2 This dose appears much lower compared to the recommended dose of 0.3 μg/kg body weight administered subcutaneously or intravenously. 3,4 Nevertheless, we agree that there are little data on the prevalence of desmopressin-induced hyponatremia after kidney biopsies. Desmopressin is usually administered to individuals with impaired renal function to reduce uremic bleed, but these patients may be at increased risk of developing desmopressin-induced hyponatremia due to prolonged desmopressin half-life in renal dysfunction. In a recent retrospective cohort study of 423 native and allograft kidney biopsies with pre-biopsy serum creatinine ≥150 μmol/L and post-biopsy electrolytes checked based on clinical indications, severe hyponatremia with serum sodium <125 μmol/L occurred after 30 biopsies (7%) at median 2 (1, 4) days after kidney biopsy (abstract presented at the 55th ERA-EDTA Congress, Copenhagen 2018). Logistic regression taking into account age, biochemistry (pre-biopsy serum sodium, urea, estimated glomerular filtration rate, proteinuria) and medications (diuretic, desmopressin dose) found that higher desmopressin dose was independently associated with severe hyponatremia after kidney biopsy [adjusted OR 1.43 (95% CI 1.03, 1.98), P = 0.03].Since desmopressin-induced hyponatremia may be an under-recognized complication of kidney biopsy and associated with significant morbidity, 5 further studies will be required to identify at-risk individuals and determine if post-biopsy biochemistry surveillance is warranted among susceptible patients administered desmopressin to reduce bleeding complications.

Response to Letter to the Editor “Hyponatremia may be an under‐recognised complication after desmopressin to reduce uremic bleeding in kidney biopsy”

“…Thank you very much for the comments in the letter to the Editor “Hyponatremia may be an under‐recognised complication after desmopressin to reduce uremic bleeding in kidney biopsy” 2019 …”