Effect of Preprocedural Desmopressin on Complications after Kidney Biopsy: A Systematic Review and Meta-Analysis

Preprocedural Desmopressin reduced the rate of bleeding complications when given intranasally or subcutaneously but not intravenously. Desmopressin results in greater odds of hyponatremia, and thus requires monitoring.

Desmopressin has a theoretical rationale to reduce procedural bleeding risk, but the results from randomized controlled trials are mixed.

PubMed, Embase, and Google Scholar were searched on October 27, 2025, to identify studies evaluating Desmopressin administered before kidney biopsy. Risk of bias was assessed using the Cochrane risk of bias 2.0 tool. Statistical analysis was performed using RevMan software to calculate odds ratios (ORs) and assess heterogeneity with the I 2 statistic. Publication bias was assessed with the Egger's test. A sensitivity analysis was performed due to heterogeneity via the leave-one-out method with revised estimated odds presented thereafter.

Seventeen studies including 5394 participants were analyzed. The pooled estimated OR for total bleeding was 0.89 (0.59 to 1.36), P = 0.60, I 2 =85%. In subgroup analysis, the pooled estimated OR for subcutaneous administration was 0.37 (0.21 to 0.65), P < 0.001, I 2 =0%; intravenous administration was 1.47 (1.05 to 2.05), P = 0.03, I 2 =61%; intranasal administration was 0.68 (0.30 to 1.56), P = 0.37, I 2 =87%; and eGFR <60 ml/min per 1.73 m 2 was 0.74 (0.40 to 1.37) P = 0.34, I 2 =81%. After sensitivity analysis, the revised OR for intranasal administration was 0.42 (0.31 to 0.59), P < 0.001 and for eGFR <60 was 0.55 (0.38 to 0.81), P = 0.002. The pooled estimated OR for severe hyponatremia was 3.85 (95% confidence interval, 2.12 to 7.00; P < 0.001; I 2 =33%).

Overall, there was no reduction in odds of bleeding but with high between-group heterogeneity. There were lower odds of bleeding in the intranasal and subcutaneous administration subgroups. Desmopressin resulted in higher odds of hyponatremia.