Desmopressin acetate in percutaneous ultrasound-guided kidney biopsy: a randomized controlled trial.
Author(s): Manno C, Bonifati C, Torres DD, Campobasso N, Schena FP
Affiliation(s): Nephrology, Dialysis and Transplant Unit, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, Bari, Italy. firstname.lastname@example.org
Publication date & source: 2011-06, Am J Kidney Dis., 57(6):850-5. Epub 2011 Feb 26.
Publication type: Clinical Trial, Phase IV; Comparative Study; Randomized Controlled Trial
BACKGROUND: Bleeding complications occur in one-third of percutaneous kidney biopsies and increase costs of the hospital stay. The aim of the study was to evaluate the effect of prebiopsy administration of desmopressin acetate versus placebo in the incidence of postbiopsy bleeding complications. STUDY DESIGN: Double-blind randomized controlled clinical trial. SETTING & PARTICIPANTS: We enrolled all patients with serum creatinine level </=1.5 mg/dL and/or estimated glomerular filtration rate >/=60 mL/min/1.73 m(2) and normal coagulation parameters undergoing ultrasound-guided biopsy of the native kidney in our unit from August 2008 to December 2009. INTERVENTION: We examined prebiopsy subcutaneous administration of desmopressin acetate, 0.3 mug/kg, compared with placebo. OUTCOMES & MEASUREMENTS: The primary outcome was incidence of bleeding complications. Secondary outcomes were hematoma size, postbiopsy hemoglobin level, coagulation parameters, glomerular filtration rate, blood pressure, and length of hospital stay. RESULTS: 162 adult patients (88 men and 74 women) were enrolled; 80 were allocated to desmopressin treatment, and 82, to the placebo group. Desmopressin compared with placebo significantly decreased the risk of postbiopsy bleeding (11 of 80 [13.7%] vs 25 of 82 [30.5%]; relative risk, 0.45; 95% CI, 0.24-0.85; P = 0.01), hematoma size (median, 208 [25th-75th percentile, 120-300] vs 380 [25th-75th percentile, 270-570] mm(2); P = 0.006] in the 36 patients who experienced bleeding, and mean hospital stay (4.9 +/- 1.1 vs 5.9 +/- 1.7 days; P = 0.004); postbiopsy hemoglobin levels were not affected significantly in either group. LIMITATION: Single-center design of the study. CONCLUSIONS: Prebiopsy desmopressin administration decreases the risk of bleeding and hematoma size in patients undergoing percutaneous kidney biopsy without a cost increase. Copyright (c) 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.