Safety of renal biopsy bleeding prophylaxis with desmopressin

Abstract

Background Percutaneous renal biopsy (PRB) is invasive, and bleeding-related complications are a concern. Desmopressin (DDAVP) is a selective type 2 vasopressin receptor-agonist also used for haemostasis. Aim To evaluate the side effects of intravenous (IV) weight-adjusted desmopressin preceding PRB. Methods This was a retrospective study of renal biopsies performed by nephrologists from 2013 to 2017 in patients who received single-dose DDAVP pre-PRB. Results Of 482 PRBs, 65 (13.5%) received DDAVP (0.3 µg/kg); 55.4% of the PRBs were native kidneys. Desmopressin indications were altered platelet function analyser (PFA)-100 results (75.3% of the patients), urea >24.9 mmol/L (15.5%), antiplatelet drugs (6.1%) and thrombocytopaenia (3%). Of the 65 patients, 30.7% had minor asymptomatic complications, and 3 patients had major complications. Pre-PRB haemoglobin (Hb) <100 g/L was a risk factor for Hb decrease >10 g/L, and altered collagen-epinephrine (Col-Epi) time was a significant risk factor for overall complications. Mean sodium decrease was 0.6 ± 3 mmol/L. Hyponatraemia without neurological symptoms was diagnosed in two patients; no cardiovascular events occurred. Conclusion Hyponatraemia after single-dose DDAVP is rare. A single IV dose of desmopressin adjusted to the patient’s weight is safe as pre-PRB bleeding prophylaxis.

Harmonizing platelet function analyzer testing and reporting in a large laboratory network

“…For comparison, some CT NRRs reported in the contemporary 6,16–29 and original literature 30–53 are shown in Figure 3. In most instances, these NRRs differ from each other and also from the manufacturer ranges, especially for C/ADP.…”

“…The Siemens product information CT NRRs are shown by the green horizontal dashed lines. Figure A shows NRRs from some contemporary literature as obtained from the recent literature search (see Methods), and reflecting information from the past 3 years 6,16–29 . Figure B shows NRRs from some early literature as otherwise reviewed in Reference 10 30–53 .…”

“…These data have arbitrarily been given a lower limit value of 50s to enable a range to be shown. One publication (Reference 18) indicated NRRs for both C/Epi and C/ADP starting at 0, which is not feasible.…”

“…As an example, the ICPMR laboratory recently , and reflecting information from the past 3 years. 6,[16][17][18][19][20][21][22][23][24][25][26][27][28][29] Figure B shows NRRs from some early literature as otherwise reviewed in Reference 10. Reference numbers identify their place in the reference list.…”