Effect of Desmopressin on Post Kidney Biopsy Bleeding Complications in Patients with Reduced Kidney Function

Key Points Desmopressin is used to reduce bleeding complications in patients with qualitative and quantitative defects in platelet function. Bleeding complications were similar between the two groups. At 24 hours postbiopsy, desmopressin had more hematoma resolution than the control. The evaluation of hematoma in two time frames, 6 and 24 hours, assesses prolonged effect of desmopressin on bleeding complications. Background Bleeding complications after a kidney biopsy are common in patients with a reduced kidney function. We performed a double-blinded, randomized controlled trial to examine the effect of desmopressin on bleeding complications after a kidney biopsy in patients with an eGFR ≤60 ml/min per 1.73 m 2 . Methods We enrolled 152 patients (mean age, 39±15 years; 51% men), of whom 74 were randomized to an interventional group (intranasal desmopressin at 3 mcg/kg 1 hour before the biopsy) and 78 to a control group (intranasal saline). The primary study outcome was the overall frequency of bleeding complications. The secondary outcome was the size of the perinephric hematoma at 6 and 24 hours, assessed by a standardized ultrasound. Results The baseline characteristics of the two treatment groups were well balanced. Overall, bleeding complications occurred in 64 of 152 (42%) of the study cohort, with 27 of 74 (36%) observed in the desmopressin group and 37 of 78 (47%) in the control group (risk ratio, 0.77; 95% confidence interval, 0.52 to 1.13; P = 0.17). The median hematoma size was similar in both groups at 6 hours (1.5 versus 2.7 ml, P = 0.34) and at 24 hours (1.2 versus 2.0 ml, P = 0.70). The frequency of a perinephric hematoma was similar in the desmopressin and placebo groups at 6 hours (35% versus 46%, P = 0.17), but lower in the desmopressin group at 24 hours (19% versus 36%, P = 0.02). Among the major bleeding complications, the frequency of blood transfusion (8.1% versus 6.4%, P = 0.69) and embolization (2.7% versus 1.3%, P = 0.61) was similar between the two groups. Conclusions In patients with a reduced kidney function, the administration of desmopressin before a kidney biopsy does not reduce the frequency of bleeding complications or the postbiopsy perinephric hematoma volume at 6 or 24 hours.