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Abstract: TH-PO1122

Transient Hypotension After Renal Biopsy Did Not Predict Major Bleeding Complication

Session Information

Category: CKD (Non-Dialysis)

  • 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Takeuchi, Yoichi, Tohoku University Hospital, Sendai, Japan
  • Nagasawa, Tasuku, Tohoku University Hospital, Sendai, Japan
  • Miyazaki, Mariko, Tohoku University Hospital, Sendai, Japan
  • Ito, Sadayoshi, Tohoku University Hospital, Sendai, Japan
Background

The vasovagal reflex during the renal biopsy is likely to be considered less serious. We revealed that the reflex was one of the uncomfortable complications that impair QOL of the patients (Yoichi T et al. Clin Exp Nephrol., 2018). Here, we aimed to examine the association between the transient hypotensive events and the amount of retroperitoneal bleeding, accurately quantified by computed-tomographic (CT) images of all patients after the renal biopsy. And, we conducted a risk assessment of the major complication.

Methods

This is a single-center retrospective observational study. A total of 454 Japanese patients underwent ultrasound-guided renal biopsy at our hospital from 2013 through 2017. Demographic factors, eGFR, hemoglobin concentration, platelet counts, and renal volume were included as covariates. Renal and bleeding volumes were 3D-reconstructed from CT images. Major complications (blood transfusion, angiographic intervention and bladder obstruction) were defined as primary outcome and peritoneal bleeding volume as secondary outcome. Logistic regression analysis was used to control the possible confounders related to bleeding complications.

Results

Accurately measured by using the CT images, the retroperitoneal bleeding of total 454 patients had median amount of 40.3 mL (IQR: 19.6 - 88.2). Transient hypotensive events occurred in 26 patients (5.7%), with major bleeding complications occurring in 18 patients (3.9%). Significant difference was found in the retroperitoneal bleeding between the groups with and without transient hypotensive event (median 237.6 mL [IQR: 2.34 - 638.4] vs. median 38.9 mL [IQR: 1.00 - 974.0], P = 0.0011). A transient hypotensive event was associated with retroperitoneal bleeding of 100 mL or more by using logistic regression model (adjusted odds ratio 4.9 [95%CI: 2.12 - 11.30], P < 0.001). The hypotensive events, however, did not associated with major bleeding complications, and the risk factors for the complications were observed in lower eGFR and lower hemoglobin concentration before the biopsy, consistent with previous reports.

Conclusion

The vasovagal reflex after renal biopsy predicted substantial amount of retroperitoneal bleeding, but it had no association with the major bleeding complications. Major complication would develop owing to the other potential etiologies besides the absolute amount of bleeding.