Effect of Preprocedural Desmopressin on Complications after Renal Biopsy

Background: Desmopressin has a theoretical rationale to reduce procedural bleeding risk but results from randomized controlled trials are mixed. Methods: PubMed, EMBASE, and Google Scholar were searched on October 27, 2025 to identify studies evaluating Desmopressin administered prior to kidney biopsy. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Statistical analysis was performed using RevMan software to calculate Odd’s Ratios and assess heterogeneity with the I 2 statistic. Publication bias was assessed with Egger’s test. A sensitivity analysis was performed due to heterogeneity via the leave-one-out method with revised estimated odds presented thereafter. Results: 17 studies including 5394 participants were analyzed. The pooled estimated odds ratio (OR) for total bleeding was 0.89 [0.59 - 1.36], p = 0.60, I 2 = 85%. In subgroup analysis the pooled estimated OR for subcutaneous administration was 0.37 [0.21 - 0.65], p < 0.001, I 2 = 0%); intravenous administration was 1.47 [1.05 - 2.05], p =0.03, I 2 = 61%; intranasal administration was 0.68 [0.30 - 1.56], p = 0.37, I 2 = 87%; and estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m 2 was 0.74 [0.40 - 1.37 p =0.34, I 2 = 81%. After sensitivity analysis the revised OR for intranasal administration was 0.42 [0.31 - 0.59], p <0.001 and for eGFR < 60 was 0.55 [0.38 - 0.81], p = 0.002. The pooled estimated OR for severe hyponatremia was 3.85 (95% CI [2.12 - 7.00], p <0.001, I 2 = 33%. Conclusions: Overall there was no reduction in odds of bleeding but with high between-group heterogeneity. There were lower odds of bleeding in the intranasal and subcutaneous administration subgroups. Desmopressin resulted in higher odds of hyponatremia.