Abstract: FR-PO0835
Heterogeneity in Randomized Clinical Trials Regarding Desmopressin Use Before Kidney Biopsy to Prevent Bleeding
Session Information
- Glomerular Clinical Trials: From Data to Impact
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Gogula, Naga Sai Akhil Reddy, Duke University School of Medicine, Durham, North Carolina, United States
- Vaidya, Palavi, Duke University School of Medicine, Durham, North Carolina, United States
- Sparks, Matthew A., Duke University School of Medicine, Durham, North Carolina, United States
Background
Several randomized clinical trials have evaluated desmopressin in patients with reduced kidney function undergoing biopsy. Conflicting results may stem from heterogeneity in study design. We conducted a comparative analysis of methodologies across all existing RCTs on desmopressin use in this context.
Methods
We conducted a comprehensive literature search to identify all randomized controlled trials (RCTs) evaluating desmopressin as a hemostatic agent in patients undergoing kidney biopsy. Searches were performed in Medline, Embase, and the Cochrane Central Register of Controlled Trials from database inception through May 2025. Eligible RCTs were assessed for key methodological and reporting characteristics, including sample size, study location, desmopressin dose and route of administration, comparator group, baseline estimated glomerular filtration rate (eGFR), and incidence of post-biopsy hematoma.
Results
5 RCTs were identified (Table 1).
Most trails had small patient size (< 200) with only one enrolling 203 patients. Dosing, route (mostly intranasal), and baseline eGFR varied across studies. Control arms also differed (often intranasal saline). Manno (2011) and Prasad (2025) showed reduced bleeding/hematomas; Sethi (2024) and Chakrabarti (2025) found no clear benefit in low eGFR. Sattari (2022) reported safety and efficacy across eGFR levels. Efficacy appears context-dependent, influenced by renal function, dose, and route. Hyponatremia was noted in some studies, likely from water retention; others didn’t report sodium levels.
Conclusion
RCTs on desmopressin before kidney biopsy in reduced kidney function showed heterogeneity in design, dosing, route, controls, and eGFR. Results were mixed; benefit appears context dependent. Hyponatremia reporting was inconsistent. Future trials need standard dosing, clear eGFR cutoffs, consistent outcomes, and routine safety checks to clarify desmopressin’s role.
Table 1
| Name and Year | Country | No. of patients | Route of administration of Desmopressin | Dose administered | Control | eGFR | Primary Outcome | Safety |
| Manno et al, 2011 | Italy | 162 | Subcutaneous (S/C) | 0.3 μg/kg | S/C saline | ≥60 mL/min/1.73 m2 | Bleeding complications: 13.7% (desmopressin) vs. 30.5% (control), P=0.01 Smaller hematoma size: 208 mm2 (desmopressin) vs. 380 mm2 (control), P=0.006 | No serious adverse events Mild transient tachycardia in 3 patients |
| Sattari et al, 2022 | Iran | 120 | Intranasal | 3 μg/kg | Intranasal NaCl 0.65% | 15-90 mL/min/1.73 m2 | Hematoma incidence: 11.6% (desmopressin) vs. 40% (control), P < 0.05 Smaller hematoma volume: 2.31 mm3 (desmopressin) vs. 7.72 mm3 (control), P < 0.05 | No major adverse events No significant hyponatremia or blood pressure changes |
| Sethi et al, 2024 | India | 80 | Intranasal | 150 μg/kg | Intranasal saline | 20.82 mL/min/1.73 m2 | More minor bleeding with desmopressin: 17.5% vs. 2.5% (P = 0.02) No significant reduction in major complications: 7.5% (desmopressin) vs. 0% (control), P = 0.15 | No significant difference in hypotension, flushing, and vasovagal syncope |
| Chakrabarti et al, 2025 | India | 152 | Intranasal | 3 μg/kg | Intranasal saline | ≤ 60 mL/min/1.73 m2 | Bleeding: 36% (desmopressin) vs. 47% (control), P = 0.17 Lower hematoma frequency at 24h: 19% (desmopressin) vs. 36% (control), P = 0.02 | Asymptomatic hyponatremia No difference in major complications (transfusion/embolization) |
| Prasad et al, 2025 | India | 203 | Intranasal | 300 μg/kg | Intranasal saline | > 30 mL/min/1.73 m2 (n =102) and < 30 mL/min/1.73 m2 (n = 101) | Bleeding: 11.9% (desmopressin) vs. 33.3% (control), P = 0.0003 Hematoma formation: 11.9% (desmopressin) vs. 30.4% (control), P = 0.001 | Nasal discomfort: 28.7% (desmopressin) vs. 5.8% (control) Headache: 7.9% (desmopressin) vs. 1.9 (control) Transient hyponatremia |