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Войти в исследования Nephrology (Carlton, Vic.) · 2026
Efficacy of Desmopressin for Post-Kidney Biopsy Bleeding Complications Prevention: A Systematic Review With Frequentist and Bayesian Meta-Analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Chen Jia-Jin, Lee Tao-Han, Lai Pei-Chun, Tu Yu-Kang, Hsu Hsiang-Hao, Yang Huang-Yu, Huang Yen-Ta, Chang Chih-Hsiang
Аннотация
AIM: Desmopressin was hypothesised to prevent post-kidney biopsy bleeding; however, its efficacy in reducing bleeding and bleeding-related complications has yet to be systematically examined.
METHODS: Relevant studies from online electronic databases up to 15 May 2025 were identified. Randomised controlled trials (RCT) reporting the efficacy of desmopressin for prevention of adult post-kidney bleeding complications were included. A random-effect meta-analysis, trial sequential analysis and Bayesian meta-analysis were conducted. We assessed the certainty of the evidence (CoE) by using the GRADE methodology.
RESULTS: Seven RCTs comprising 827 participants were included. By analysis of all seven studies, desmopressin shows a trend of reducing all post biopsy bleeding events (risk ratio [RR] = 0.77, 95% CI = 0.37-1.59) with very low CoE. In a sensitivity analysis excluding an outlier trial, desmopressin was associated with a lower risk of any bleeding and reduced heterogeneity (RR = 0.56, 95% CI = 0.39-0.80; I2 = 56%; moderate CoE). Desmopressin did not reduce post biopsy gross hematuria (RR: 1.00, 95% CI: 0.42-2.36), severe bleeding needs blood transfusion (RR = 1.46, 95% CI = 0.66-3.23), or invasive intervention (RR = 1.39, 95% CI = 0.38-5.09). A Bayesian analysis estimated a 76% posterior probability of any benefit, although the 95% credible interval indicated imprecision. Desmopressin is also associated with an RR of 4.52 (95% CI = 2.05-9.94; I2 = 0.0%) for hyponatremia.
CONCLUSION: Desmopressin may reduce overall bleeding after kidney biopsy; however, low-certainty evidence and imprecise estimates are noted, necessitating further large-scale studies to explore its potential benefit, particularly in high-risk populations.
METHODS: Relevant studies from online electronic databases up to 15 May 2025 were identified. Randomised controlled trials (RCT) reporting the efficacy of desmopressin for prevention of adult post-kidney bleeding complications were included. A random-effect meta-analysis, trial sequential analysis and Bayesian meta-analysis were conducted. We assessed the certainty of the evidence (CoE) by using the GRADE methodology.
RESULTS: Seven RCTs comprising 827 participants were included. By analysis of all seven studies, desmopressin shows a trend of reducing all post biopsy bleeding events (risk ratio [RR] = 0.77, 95% CI = 0.37-1.59) with very low CoE. In a sensitivity analysis excluding an outlier trial, desmopressin was associated with a lower risk of any bleeding and reduced heterogeneity (RR = 0.56, 95% CI = 0.39-0.80; I2 = 56%; moderate CoE). Desmopressin did not reduce post biopsy gross hematuria (RR: 1.00, 95% CI: 0.42-2.36), severe bleeding needs blood transfusion (RR = 1.46, 95% CI = 0.66-3.23), or invasive intervention (RR = 1.39, 95% CI = 0.38-5.09). A Bayesian analysis estimated a 76% posterior probability of any benefit, although the 95% credible interval indicated imprecision. Desmopressin is also associated with an RR of 4.52 (95% CI = 2.05-9.94; I2 = 0.0%) for hyponatremia.
CONCLUSION: Desmopressin may reduce overall bleeding after kidney biopsy; however, low-certainty evidence and imprecise estimates are noted, necessitating further large-scale studies to explore its potential benefit, particularly in high-risk populations.