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

Abstract

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.

Thrombin Generation and Platelet Function in ICU Patients Undergoing CVVHD Using Regional Citrate Anticoagulation

“…Multifaceted hemostatic imbalances are an issue especially in critically ill patients requiring renal replacement therapy (CRRT): the contact of blood with foreign surfaces activates procoagulant processes ( 9 ) further aggravating the per se prothrombotic risk related to critical illness ( 1 – 3 ), whereas uremic platelet dysfunction is accompanied by a bleeding tendency ( 9 , 15 , 16 ). Caught between an increased risk of bleeding complications on the one hand and thrombosis on the other hand, anticoagulation of the extracorporeal circulation is a particular challenge.…”

Case Report: Hyponatremia Secondary to Desmopressin Administration Prior to Percutaneous Kidney Biopsy: A Case-Based Review

“…In two other retrospective studies, in patients at high risk of bleeding (eGFR <60 ml/min; serum creatinine >1.5 mg/dl), hyponatremia incidence (<130 mmol/l) was 10 and 9%, respectively, all events being asymptomatic ( 18 , 19 ). In one of these studies ( 19 ), desmopressin given intranasally (150 μg) reduced by two-fold the risk of post-biopsy bleeding but a decrease in sodium level was noted in 94% of patients, with a mean decrease of 4.35 mmol/l.…”

“…Thus, data from these studies suggest that incidence of hyponatremia (<130 mmol/l) after desmopressin use for bleeding prophylaxis in high-risk patients (eGFR <60 ml/min) is around 10% but is seldom symptomatic (11,(17)(18)(19). The major predictors of vasopressin-associated hyponatremia are high hypotonic oral fluid intake (=imposed by pre-existent polyuria or by biopsy protocol), lower pre-biopsy serum sodium, higher urinary spot sodium and higher desmopressin dose (11,17,19).…”

Safety of Obtaining an Extra Biobank Kidney Biopsy Core

“…Thus, it is important to consider the thickness of the needle used for the puncture and the number of cores that are usually obtained. Several studies that have been focused on post-kidney biopsy complications detailed these relevant aspects [ 12 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ] ( Table 7 ).…”

“…However, in a few studies, the KB protocol details are not explained [ 13 , 14 , 36 ]. The thickness of the needles used most frequently was 16G or 18G; usually, the choice of the needle size depends on the professional who performs the kidney biopsy [ 25 , 27 , 28 , 29 , 30 , 33 ]. In other cases, the size of needle that they used is defined by protocol of the center [ 12 , 26 , 31 , 32 , 33 , 34 , 35 ].…”