EFFECT OF DESMOPRESSIN ON POST-KIDNEY BIOPSY BLEEDING (DEPOST-KB): A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY

Introduction:

Post-kidney biopsy bleeding poses a significant risk, particularly in patients with compromised renal function due to uremic toxins. Desmopressin, known for its role in increasing von Willebrand factor (vWF) and Factor VIII, may reduce bleeding complications. This study aimed to evaluate the efficacy of intra-nasal desmopressin acetate in preventing post-biopsy bleeding compared to a placebo

Methods:

We conducted a double-blind, randomized, placebo-controlled clinical trial from February 2020 to January 2023 at the nephrology department of a major referral center in Lucknow, India. Adults (18-65 years) undergoing kidney biopsy for various indications were eligible. Participants were randomly assigned to receive either 300 mcg desmopressin or placebo (normal saline) intranasally 1 hour before the biopsy. The primary outcome was post-biopsy bleeding incidence. Secondary outcomes included hemoglobin drop >1 g/dL, hypotension, hematoma, and the need for transfusion or radiological/surgical interventions. Blood samples were analysed for vWF and Factor VIII levels, and thromboelastography (TEG) parameters

Results:

A total of 203 patients were enrolled ;101 in desmopressin arm and 102 in placebo arm. Mean age was 40.6 (15.21); baseline characters were comparable between groups. Desmopressin significantly reduced the incidence of bleeding (11.9%) compared to placebo (33.3%, p=0.0003), with a relative risk (RR) of 0.356 (95% CI, 0.196–0.648, p=0.0007). Hematomas were more common in the placebo group (30.4%) than in desmopressin group (11.9%, p=0.001). The need for blood transfusion was similar between groups (4.95% desmopressin vs. 2.94% placebo, p=0.46). A significant difference was observed in the incidence of hemoglobin drop >1 g/dL, higher in the desmopressin group(30.69% vs. 17.64%, p=0.03) possibly due to hemodilution. Desmopressin significantly increased Factor VIII and VWF levels at 2 hours compared to placebo (Factor VIII: 20.4 ± 1.9 vs 7.6 ± 0.71 ng/ml, VWF: 48.06 ± 5.3 vs 25.83 ± 4.7 ng/ml; P < 0.001. Hyponatremia was more frequent in desmopressin group (28.7% Vs 5.8%, p<0.001). No patient required nephrectomy or died during the study

Subgroup Analysis: Stratification by eGFR revealed: eGFR >30 ml/min/1.73m²:Bleeding incidence was lower in the desmopressin group (5.9%) compared to placebo (23.5%, p=0.01), with an RR of 0.25 (95% CI, 0.075–0.833, p=0.02). The number needed to treat (NNT) to prevent one bleeding episode was 5.667. eGFR <30 ml/min/1.73m²: Desmopressin also reduced bleeding incidence (18%) compared to placebo (43.1%, p=0.006), with an RR of 0.42 (95% CI, 0.213–0.815, p=0.010). The NNT was 3.978

Conclusions:

Desmopressin effectively reduces post-kidney biopsy bleeding across varying levels of eGFR when used in appropriate intra-nasal doses, demonstrating its utility in clinical settings. While it substantially lowers bleeding risk, it is associated with a higher incidence of non-severe hyponatremia, which require monitoring. The findings, demonstrating both mechanistic and clinical benefits, support the use of desmopressin in patients undergoing kidney biopsy

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.