Kidney Week

Abstract: SA-PO0926

Efficacy of Desmopressin in Reducing Bleeding in High-Risk Native Kidney Biopsy: Systematic Review and Meta-Analysis

Session Information

• Pathology: Updates and Insights
  November 08, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pathology and Lab Medicine

• 1800 Pathology and Lab Medicine

Authors

• Sartori Pacini, Gabriel, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil

Gabriel Sartori Pacini

• Pascoal, Mateus Guimarães, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil

Mateus Guimarães Pascoal, MD

• Bertuol, Vanderlei Carlos, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil

Vanderlei Carlos Bertuol, MD

• Schuchmann, Renata Asnis, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil

Renata Asnis Schuchmann, MD

• Manfro, Arthur Gus, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil

Arthur Gus Manfro, MD, PhD

• Steckert, Gabriela Vieira, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil

Gabriela Vieira Steckert

• Martins Filho, Cleuber Gea, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil

Cleuber Gea Martins Filho, MD

• Manfro, Roberto C., Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil

Roberto C. Manfro, MD, PhD

• Bauer, Andrea Carla, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil

Andrea Carla Bauer, MD, PhD

Background

Kidney biopsy is an essential diagnostic procedure in nephrology, but it carries a bleeding risk, especially in patients with impaired kidney function. Desmopressin (DDAVP) is sometimes used prophylactically to mitigate this risk, though its efficacy remains uncertain. This study aimed to evaluate the effectiveness of DDAVP in reducing bleeding complications in high-risk patients undergoing native kidney biopsy through a systematic review and meta-analysis.

Methods

We searched PubMed, EMBASE, Cochrane, ClinicalTrials.gov, and conference proceedings up to April 2025 for randomized and observational studies comparing DDAVP to placebo or no treatment in patients with impaired kidney function (eGFR <60 mL/min/1.73 m2). Risk of bias was assessed using the RoB-2 and Newcastle-Ottawa Scale. The primary outcome was the incidence of bleeding events. Pooled risk ratios (RR) were calculated using a random-effects model. Subgroup and sensitivity analyses, including leave-one-out diagnostics, were performed.

Results

Nine studies with 2,470 patients were included. The overall pooled RR for bleeding was 0.61 [95% CI: 0.33–1.11], with high heterogeneity (I2 = 73.6%). Observational studies showed a significant reduction in bleeding (RR = 0.52 [95% CI: 0.44–0.61], I2 = 0%), while randomized controlled trials did not (RR = 0.87 [95% CI: 0.10–7.69], I2 = 89.3%). A leave-one-out analysis identified a single outlier study that, when excluded, significantly reduced heterogeneity (I2 = 18.3%) and rendered the pooled effect statistically significant (p < 0.0001). No consistent difference was found in major or minor bleeding rates in RCTs. Egger’s test did not indicate publication bias.

Conclusion

DDAVP may reduce bleeding risk in high-risk patients undergoing native kidney biopsy, particularly in real-world observational settings. The benefit became statistically significant after removing a single outlier study. These findings support the cautious use of DDAVP in selected patients and underscore the need for well-powered RCTs to confirm its efficacy.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.20255j9npqs8