Kidney Week

Abstract: SA-PO636

The Impact of Desmopressin on Native Kidney Biopsy Complications

Session Information

• Glomerular Diseases: ANCA, Anti-GBM, Kidney Biopsy
  November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

• Leclerc, Simon, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada

Simon Leclerc,

• Elftouh, Naoual, Hôpital Maisonneuve Rosemont, Montreal, Quebec, Canada

Naoual Elftouh,

• Lafrance, Jean-Philippe, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada

Jean-Philippe Lafrance,

• Nadeau-Fredette, Annie-Claire, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada

Annie-Claire Nadeau-Fredette,

• Pichette, Vincent, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada

Vincent Pichette,

• Laurin, Louis-Philippe, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada

Louis-Philippe Laurin,

Background

As bleeding is a feared complication of native kidney biopsy (NKB), nephrologists often prescribe desmopressin in an attempt to lower its occurrence, especially for patients with reduced estimated glomerular filtration rate (eGFR) at risk of uremia-related platelet dysfunction. However, only one randomized study has analyzed its effect before NKB on patients with eGFR >60 mL/min/m²whereas retrospective studies on patients with eGFR <60 mL/min/m²are contradictory.

Methods

This study aims to evaluate the impact of desmopressin on complications after NKB. We reviewed medical records of every adult patient who had a NKB at our tertiary teaching hospital from April 2013 to April 2018. We collected data concerning the medical history of each patient and their clinical parameters before and after each NKB. We used multivariate logistic regressions to evaluate the effect of desmopressin on the occurrence of hemoglobin fall, transfusions, hypotension, acute kidney injury (AKI), hematomas and additional radiologic examinations.

Results

Among the 413 NKB analyzed, 79.4% were done after a dose of desmopressin. Patients who received desmopressin had more severe chronic kidney disease at baseline (eGFR 39 vs 54 mL/min/m²; p=0.0003) and were more often hospitalized before the biopsy (48% vs 32%; p=0.009). There was a tendency for a reduction in symptomatic hematomas (OR=0.34; 95%CI: 0.11-1.19; p=0.08) and a significant reduction of post-biopsy additional radiologic examinations (OR=0.22; 95%CI: 0.07-0.73; p=0.01) in the desmopressin group. Desmopressin had a neutral effect on other complications (see table) and on hyponatremia.

Conclusion

Our results were affected by an indication bias, because sicker patients were more likely to receive desmopressin and IV fluids causing hemodilution. However, after adjustment for potential cofounders, desmopressin seems to reduce post-biopsy symptomatic hematomas and additional radiologic examinations, implying important clinical and financial benefits.