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Desmopressin for the prevention of bleeding in percutaneous kidney biopsy: efficacy and hyponatremia

  • Nephrology - Original Paper
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Abstract

Background

Desmopressin is used to reduce bleeding complications for kidney biopsies with azotemia but little is known about desmopressin-induced hyponatremia in these individuals. We aimed to evaluate the impact of desmopressin prophylaxis on severe hyponatremia and bleeding after kidney biopsies in individuals with renal impairment.

Method

This is a single-center retrospective cohort study of consecutive adults with serum creatinine ≥ 150 µmol/L and had ultrasound-guided percutaneous native or transplant kidney biopsies between June 2011 and July 2015. Data were retrieved from electronic medical records. Primary outcomes were the use of desmopressin prophylaxis and severe hyponatremia (serum sodium ≤ 125 mmol/L) within 7 days post-biopsy. Secondary outcome was post-biopsy bleeding.

Results

240 native kidney and 196 allograft biopsies were performed. Median age was 51 (IQR 42.3, 60) years and eGFR was 21.9 (12.9, 30.1) ml/min/1.73 m2. Although patients prescribed desmopressin prophylaxis (n = 226) had higher serum creatinine [279 (201, 392) vs. 187 (160, 241), p < 0.001], bleeding (15.0% vs. 13.3%, p = 0.60) was not significantly different with and without desmopressin. Severe hyponatremia occurred in 30 biopsies (6.9%) with nadir serum sodium level of 122 (119, 124) mmol/L at 3 (2, 5) days after biopsy, more frequently among those with desmopressin prophylaxis (10.7% vs. 3.0%, p = 0.002). Multi-variate analysis found that pre-biopsy serum sodium level [adjusted OR 0.80 (95% CI 0.72, 0.90), p < 0.001] and desmopressin prophylaxis [adjusted OR 4.02 (95% CI 1.58, 10.21), p = 0.003] were independently associated with severe hyponatremia after kidney biopsy.

Conclusion

Pre-biopsy desmopressin was associated with severe hyponatremia in individuals with renal impairment; hence, susceptible patients given desmopressin should be closely monitored.

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Acknowledgment

We thank our colleagues at the Department of Renal Medicine for their support in the course of this study.

Funding

No financial funding relevant to this study.

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Authors and Affiliations

  1. Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore

    Cynthia C. Lim, Jason C. J. Choo, Mayank Chawla, Yok Mooi Chin, Terence Kee, Marjorie Foo & Chieh Suai Tan

  2. Pharmacy, Singapore General Hospital, 1 Hospital Drive, Outram Road, Singapore, Singapore

    Benson Siow & Puay Hoon Lee

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  1. Cynthia C. Lim
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Contributions

All authors contributed to the intellectual development of this paper. TCS, JC and CL designed the study. BS, MC and YMC retrieved data. CL analyzed data and wrote the initial draft. BS, TK, PHL, MF, JC and TCS provided critical corrections to the manuscript. The final version of the paper was seen and approved by all the authors.

Corresponding author

Correspondence to Cynthia C. Lim.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethics statement

All study procedures, including waiver of informed consent for medical records review, were approved by the institutional research committee and performed in accordance with the 1964 Helsinki declaration.

Informed consent

This study abided by the Declaration of Helsinki and waiver of informed consent was approved by the Institutional Review Board (CIRBE 2017/2647).

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Lim, C.C., Siow, B., Choo, J.C.J. et al. Desmopressin for the prevention of bleeding in percutaneous kidney biopsy: efficacy and hyponatremia. Int Urol Nephrol 51, 995–1004 (2019). https://doi.org/10.1007/s11255-019-02155-9

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