Desmopressin and bleeding risk in high-risk native kidney biopsy: updated meta-analysis of RCTs and observational...

Area of Science:

• Nephrology
• Hematology
• Pharmacology

Background:

• Kidney biopsy carries bleeding risks, especially in patients with impaired kidney function.
• Desmopressin (DDAVP) is sometimes used prophylactically, but its effectiveness is uncertain.
• High-risk patients undergoing native kidney biopsy require evaluation for bleeding risk mitigation.

Purpose of the Study:

• To systematically review and meta-analyze the efficacy of DDAVP in reducing bleeding complications.
• To assess DDAVP's effect in high-risk patients with impaired kidney function (eGFR <60 mL/min/1.73 m²).

Main Methods:

• Systematic review and meta-analysis of randomized and observational studies.
• Searched PubMed, EMBASE, Cochrane, and ClinicalTrials.gov up to April 2025.
• Pooled risk ratios (RRs) using random-effects models; conducted subgroup and sensitivity analyses.

Main Results:

• Nine studies (n=2,470) were included. Overall pooled RR for bleeding was 0.61 (95% CI, 0.33-1.11) with high heterogeneity.
• Observational studies showed a significant bleeding reduction (RR=0.52), while RCTs did not (RR=0.87).
• Sensitivity analysis excluding an outlier reduced heterogeneity and showed a significant pooled effect (p < .0001).

Conclusions:

• Overall analysis lacked statistical significance, but observational data and sensitivity analyses suggest a potential protective effect of DDAVP.
• Findings are exploratory due to low certainty of evidence; larger RCTs are needed.
• Further research should confirm efficacy and better characterize safety of DDAVP for kidney biopsy bleeding prevention.