Kidney biopsy in the elderly: Safety and strategies to prevent uremic bleeding

Lim, Cynthia Ciwei; Huang, Huijun; Chin, Yok Mooi; Teng, Wei; Woo, Keng Thye

doi:10.1111/nep.13528

Cited by 6 publications

(3 citation statements)

References 6 publications

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“…As previously reported in multiple studies [12][13][14][15][16], the percentage of elderly patients undergoing renal biopsy, over the years, has increased in our center. Among elderly and non-elderly patients with renal disease, the risk of undergoing renal biopsy is comparable [6,17]. In addition, nephrologists may be more willing to perform biopsy in elderly patients in recent years compared to the past.…”

Section: Discussionmentioning

confidence: 99%

Clinical and pathological analysis of renal biopsies of elderly patients in Northeast China: a single-center study

et al. 2021

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Purpose: To identify the clinical characteristics, histopathological features, and prognosis of kidney disease in a large cohort of elderly patients from Northeast China. Methods: We retrospectively analyzed the renal disease spectrum in 7,122 patients who underwent renal biopsies at the Second Hospital of Jilin University from 2006 to 2020. Patients were grouped according to age: below 60 years (non-elderly group, n ¼ 5923) and at least 60 years (elderly group, n ¼ 1199). The clinical and pathological characteristics of renal biopsy patients in the groups were analyzed using the t-test and chi-square test. Results: Compared with the non-elderly group, the elderly group had significantly fewer patients with primary glomerulonephritis, but more patients with tubulointerstitial disorders (p < .05). The incidence of IgA nephropathy, mesangial proliferative glomerulonephritis, and lupus nephritis was significantly lower in elderly patients than in non-elderly patients. The incidence of membranous nephropathy, membranoproliferative glomerulonephritis, diabetic nephropathy, hypertensive nephropathy, systemic vasculitis-associated renal damage, and amyloid nephropathy was significantly higher in elderly patients than in non-elderly patients (p < .05). The incidence of perinephric hematoma (!4 cm 2 ) in elderly patients with renal biopsy was lower than that in non-elderly patients. We noted that 79.9% of primary glomerulonephritis patients who received immunosuppressive therapy showed a remission rate of 83.5%. Conclusion:The spectrum of kidney disease in the elderly is different from that in the younger population.

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Section: Discussionmentioning

confidence: 99%

Clinical and pathological analysis of renal biopsies of elderly patients in Northeast China: a single-center study

et al. 2021

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“…While it was possible that voluntary participation may result in selection bias if nonresponders rejected the study because they had vaccine hesitancy, we found that vaccine uptake was not different between nonresponders and responders. The HLS-EU-47 questionnaire was intended to be self-administered but we adapted its administration to a telephone interview due to a move toward teleconsultations during the pandemic with reduced in-person clinic visits, while electronic mail or online self-administered surveys may result in even lower response rates since our patients with glomerulonephritis are increasingly older and some may be less adept using these technology [ 26 ]. Although few socioeconomic status measures differentiated health literacy in this cohort, this may be due to the predominantly middle-class nature of the cohort with few patients in the extremities of the socioeconomic status spectrum, thus limiting the ability to detect significant associations with health literacy.…”

Section: Discussionmentioning

confidence: 99%

A Descriptive Evaluation of Health Literacy and Determinants of COVID-19 Vaccine Acceptance among Patients with IgA Nephropathy with High Vaccine Uptake

Lim

Mok²,

Leeu³

et al. 2022

Glomerular Dis

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Aims: Shared decision-making regarding COVID-19 vaccination in IgA nephropathy involves the ability to handle health information regarding potential benefits and risk of flare, but few studies have evaluated health literacy in the context of vaccination. We aimed to evaluate the health literacy and COVID-19 vaccination uptake and acceptance in IgA nephropathy. Methods: Single-center cross-sectional study of 126 consecutive patients with IgA nephropathy. Health literacy was assessed using the HLS-EU-47 questionnaire. Determinants of vaccine acceptance such as contextual influences, individual and group influences, and vaccine-specific issues were adapted from the World Health Organization framework. Results: Forty-eight patients (38.1%) with IgAN nephropathy completed the survey between June and August 2021. The participants’ median age was 40.5 (31.6, 52.8) years with median disease duration of 2.8 (1.3, 4.3) years. The median general health literacy index was 31.74 (29.88, 35.82) with significantly greater difficulty in the competency of appraising health information and in the domain of disease prevention (p<0.001). Forty-five patients (93.8%) received at least one dose of COVID-19 vaccine between January and August 2021. Among the 3 unvaccinated patients, 2 intended to receive the vaccination while and 1 did not intend to get vaccinated. There was a high level of trust and belief that their government and healthcare providers had their best interests at heart and that the healthcare providers were honest about the vaccine’s risk and benefits, although 31.2% did not understand how the vaccine works and 22.9% believed that there were other ways to prevent infection. Most thought there was adequate safety information, were confident in the system for tracking adverse events and had no issues with access to the vaccine. Conclusion: Participants with IgA nephropathy had high health literacy scores and low vaccine hesitancy. The determinants for vaccine acceptance can guide efforts to optimize vaccination coverage.

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“…As patients undergoing kidney biopsy are increasingly older and older age is associated with higher red cell transfusion rates after percutaneous kidney biopsy, 2,24 pre‐biopsy DDAVP in selected cases may be beneficial in reducing bleeding complications in addition to standard precautions. While the Swedish cohort tended to be older (desmopressin group: mean age 55.6 ± 16.6 years; no desmopressin group: 58.5 ± 17 years), Manno et al .…”

Section: Discussionmentioning

confidence: 99%

Desmopressin acetate to prevent bleeding in percutaneous kidney biopsy: a systematic review

Lim

Tan

et al. 2021

Internal Medicine Journal

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Background Kidney biopsy is the gold standard for diagnosing kidney disease but may result in bleeding, especially in uraemia. DDAVP (1‐deamino‐8‐d‐arginine vasopressin) may reduce uraemic bleeding but guidelines on its use are lacking. Aim To evaluate whether DDAVP reduced bleeding complications after percutaneous kidney biopsies. Methods We searched CENTRAL, PubMed, Embase, LILACS, WHO Trials Registry and http://clinicaltrials.gov until May 2019 for randomised controlled trials (RCT), quasi‐RCT and prospective cohort studies that compared DDAVP with placebo or no intervention, prior to native or allograft kidney biopsy. The primary outcome was post‐biopsy bleeding. Secondary outcome was adverse events related to DDAVP. Results Abstracts of 270 identified papers were examined and 24 selected for evaluation. Two studies, one RCT and one prospective cohort that collectively evaluated 738 native kidney biopsies, met the inclusion criteria. One enrolled individuals with serum creatinine ≤1.5 mg/dL (132 μmol/L) and/or estimated glomerular filtration rate ≥60 mL/min/1.73 m2 while the other evaluated biopsies with serum creatinine >150 μmol/L. DDAVP was administered as a single subcutaneous dose of 0.3 μg/kg in both studies. Data were not pooled for meta‐analysis due to clinical heterogeneity. GRADE quality of evidence from these two studies was low for DDAVP preventing any bleeding complication after native kidney biopsy. Low quality evidence suggested that adverse effects were not increased in DDAVP therapy. No prospective studies evaluated DDAVP in transplant kidney biopsies. Conclusion Currently available prospective data are insufficient to support the routine use of DDAVP prior to percutaneous kidney biopsies hence high quality trials are required.

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Kidney biopsy in the elderly: Safety and strategies to prevent uremic bleeding

Abstract: Categorical variables are expressed as n (%) and compared using χ 2 test. ‡ Bonferroni correction was performed for multiple comparisons; hence, difference was considered significant if P value was <0.0167.

Cited by 6 publications

References 6 publications

Clinical and pathological analysis of renal biopsies of elderly patients in Northeast China: a single-center study

Clinical and pathological analysis of renal biopsies of elderly patients in Northeast China: a single-center study

A Descriptive Evaluation of Health Literacy and Determinants of COVID-19 Vaccine Acceptance among Patients with IgA Nephropathy with High Vaccine Uptake

Desmopressin acetate to prevent bleeding in percutaneous kidney biopsy: a systematic review

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