Effect of desmopressin on bleeding outcomes after native renal biopsy: a systematic review and meta-analysis

Percutaneous kidney biopsy is a key diagnostic tool in nephrology but carries a risk of post-procedure bleeding, with complications ranging from minor hematomas to life-threatening hemorrhages. Desmopressin (DDAVP), a synthetic vasopressin analogue, has been used as a prophylactic agent to reduce the risk of bleeding. This systematic review and meta-analysis aims to resolve uncertainties by evaluating efficacy and safety outcomes in diverse cohorts, informing evidence-based practice for desmopressin use in native renal biopsy care. A comprehensive literature search was conducted across PubMed, Web of Science, Scopus, Cochrane Library, and ClinicalTrials.gov, covering all records up to May 2025 for randomized controlled trials that compared Desmopressin with placebo before native kidney biopsy. The primary outcome was bleeding events following kidney biopsy, with secondary outcomes focusing on adverse effects associated with Desmopressin use. A total of five randomized controlled trials (RCTs), including 717 patients undergoing native renal biopsy, were included in our study. The study found that desmopressin was significantly effective than placebo in reducing total bleeding events in 157 participants (RR 0.51, 95% CI [0.31, 0.83], P = 0.008). However, there was substantial heterogeneity, with no significant improvement in hematoma formation or blood transfusion needs. The safety parameters, including flushing incidence, systolic and diastolic blood pressure, and hemoglobin, were not significantly different between the desmopressin and placebo groups. The point estimates for the endpoints were generally consistent with no clinically significant difference between treatments. Evidence available suggests that while desmopressin reduces the cumulative incidence of bleeding after native renal biopsy, its negligible effect on clinically significant complications does not support its routine use in this setting. It did not affect clinically important endpoints such as hematoma formation or need for transfusion, and no difference in safety between the two groups was noted. It is concluded that there is no existing evidence to support the routine premedication with desmopressin before native renal biopsy, but in certain high-risk cases, its use may be contemplated until further research is pending. Further, adequately powered randomized trials are required to establish a definitive therapeutic benefit.