Routine haemostasis testing before transplanted kidney biopsy: a cohort study.

Area of Science:

• Nephrology
• Hematology
• Transplantation

Background:

• Kidney biopsy carries a risk of bleeding complications.
• Current prebiopsy bleeding time (BT) testing is controversial.
• Novel whole blood hemostasis assays may offer improved prediction.

Purpose of the Study:

• To evaluate if PFA-100 can replace BT for prebiopsy screening.
• To assess the predictive value of BT, PFA-100, MEA, and MPV for bleeding after kidney biopsy.
• To identify reliable predictors of post-biopsy bleeding.

Main Methods:

• 154 patients undergoing kidney transplant biopsies had BT, PFA-100, MEA, and MPV measured.
• Bleeding outcomes (Hb drop, hematuria, intervention) were correlated with prebiopsy tests.
• Diagnostic performance and Bland-Altman analysis were used to compare BT and PFA-100.

Main Results:

• None of the tested hemostasis assays (BT, PFA-100, MEA, MPV) predicted bleeding outcomes.
• Prior use of acetylsalicylic acid (ASA) was a significant predictor of bleeding (OR 3.19).
• PFA-100 could not substitute for BT, and routine hemostasis testing showed no added value.

Conclusions:

• Routine prebiopsy hemostasis testing is not valuable for predicting bleeding after kidney biopsy.
• Acetylsalicylic acid (ASA) use is the most significant determinant of bleeding risk.
• Current hemostasis tests, including PFA-100, do not adequately replace traditional bleeding time tests.