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Kidney Week

Abstract: TH-PO582

Transdermal Estrogen Provides Comparable Effectiveness With Desmopressin in Preventing Uremic Bleeding in CKD Patients Undergoing Kidney Biopsy: A Pilot Randomized, Double-Blinded Controlled Trial

Session Information

  • Pathology and Lab Medicine
    November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pathology and Lab Medicine

  • 1700 Pathology and Lab Medicine

Authors

  • Wipattanakitcharoen, Aschariya, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • Susantitaphong, Paweena, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • Katavetin, Pisut, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • Praditpornsilpa, Kearkiat, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • Eiam-Ong, Somchai, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
  • Takkavatakarn, Kullaya, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
Background

In CKD patients, impairment of renal function and accumulation of uremic toxins increase the risk of post-biopsy bleeding due to platelet dysfunction. A previous study revealed that estrogen could shorten the prolonged bleeding time. We conducted this study to compare the effectiveness of transdermal estrogen and desmopressin, the most common agent used in uremic patients, in preventing post-biopsy bleeding complications.

Methods

This non-inferiority, randomized, double-blinded, placebo-controlled trial enrolled patients with eGFR of less than 60 mL/min/1.73m2 undergoing kidney biopsy. Participants were randomly assigned to receive either transdermal estrogen patches (50 mcg/day) for 7 days or intravenous desmopressin (0.4 mcg/kg). The primary outcome was the incidence of post-biopsy bleeding complications (hematoma or gross hematuria). The secondary outcomes were hematoma size, changes in hemoglobin levels, platelet function assay by PFA-200, and adverse events.

Results

Twenty-one CKD patients underwent randomization to transdermal estrogen (n=10) or desmopressin (n=11) treatment. Transdermal estrogen provided comparable post-biopsy bleeding event to desmopressin (60% and 45.5%; p=0.67). There were no significant differences in hematoma size (7.44±8.4 cm2 and 7.31±11.9 cm2; p=0.98) and hemoglobin change (-0.63±1.1 g/dL and -1.2±1.3 g/dL; p=0.31) between transdermal estrogen and desmopressin respectively. A significant improvement of platelet function represented by a decrease in closure times of PFA-200 assay with collagen and epinephrine (Col/EPI) was observed in desmopressin compared with transdermal estrogen (-50±32.6 sec and 20.3±36.4 sec; p<0.001). Sodium levels significantly decreased in patients receiving desmopressin (-6.0±4.3 mmol/L; p<0.05). There was no thromboembolism event observed.

Conclusion

In CKD patients, transdermal estrogen provided comparable effectiveness to desmopressin in preventing post-biopsy bleeding complications, hematoma size, and hemoglobin change without increased risk of thromboembolism and hyponatremia.

Funding

  • Other NIH Support