Effect of Desmopressin on Post Kidney Biopsy Bleeding Complications in Patients with Reduced Kidney Function: A Randomized Controlled Trial.

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 impact of desmopressin on bleeding complications after a kidney biopsy in patients with an eGFR ≤60 ml/min/1.73m2.

Methods: We enrolled 152 patients (mean age, 39 ± 15 years; 51% males), of whom 74 were randomized to an interventional group (intranasal desmopressin at 3 mcg/kg one 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% CI 0.52-1.13, p=0.17). The median hematoma size was similar in both groups at 6 hours (1.5 vs. 2.7 ml, p=0.34) and at 24 hours (1.2 vs. 2.0 ml, p=0.70). The frequency of a perinephric hematoma was similar in the desmopressin and placebo groups at 6 hours (35 vs 46%, p=0.17), but lower in the desmopressin group at 24 hours (19 vs 36%, p=0.02). Among the major bleeding complications, the frequency of blood transfusion (8.1% vs. 6.4%, p=0.69) and embolization (2.7% vs. 1.3%, p=0.61) was similar between the two groups.

Conclusions: In patients with a reduced kidney function, administration of desmopressin prior to a kidney biopsy does not reduce the frequency of bleeding complications or the post-biopsy perinephric hematoma volume at 6 or 24 hours.