Reduction of hemorrhagic complications after non-focal renal biopsy with pre-procedure desmopressin administration.

PURPOSE: Ultrasound-guided non-focal renal biopsy (NFRB), which is performed to assess systemic renal processes, is associated with a 1.5%-14% bleeding risk. The goal of this study is to evaluate the safety and efficacy of 1-deamino-8-D-arginine vasopressin (DDAVP, or desmopressin) in mitigating bleeding risk when administered prior to NFRB.

METHODS

This retrospective observational study includes 158 patients who underwent NFRB between March 2022 and June 2025 at the study hospital before and after the implementation of a DDAVP administration protocol. Beginning in July 2023, every patient at the study site received intravenous DDAVP immediately before biopsy, regardless of renal function. Ultimately, 79 patients received DDAVP (the DDAVP group), and 79 did not receive the intervention (the non-DDAVP group). This study's primary endpoint was clinically significant bleeding (resulting in unplanned admission; intervention for bleeding, such as angiography or surgery; and/or death) within 1 week of biopsy. Secondary endpoints were hyponatremia or a thromboembolic event within 1 week of biopsy. The data from patients in the two groups were compared using Mann-Whitney U tests for nonparametric data, Student's t-tests for parametric data, and chi-squared tests for categorical data (with an alpha level of P < 0.05).

RESULTS

Six of the 79 patients (8%) in the non-DDAVP group experienced a clinically significant hemorrhage, compared with 0 in the DDAVP group (P = 0.03). Sodium levels were not significantly different between the two groups post-procedure (P = 0.43). There was no significant difference in the rate of thromboembolic events between the two groups [2/79 (2.5%) in the non-DDAVP group vs. 3/79 (3.8%) in the DDAVP group; P = 1.00]. The 5 patients (out of 158; 3.2%) who experienced a thromboembolic event within 1 week of NFRB had been on anticoagulants or antiplatelet agents that were held for biopsy.

CONCLUSION

DDAVP is associated with a reduction in unplanned hospitalizations and bleeding interventions (angiography and embolization) after NFRB, without an observed increase in thromboembolic events.

CLINICAL SIGNIFICANCE: Routine DDAVP administration before NRFB significantly reduces clinically significant bleeding, supporting its potential role as a simple prophylactic strategy.