Desmopressin acetate (DDAVP) to prevent bleeding in percutaneous kidney biopsy: a systematic review
Internal medicine journal. 2020
BACKGROUND Kidney biopsy is the gold standard for the diagnosing kidney disease but may result in bleeding, especially in uremia. DDAVP (1-deamino-8-D-arginine vasopressin) may reduce uremic bleeding but guidelines on its use are lacking. We aimed to evaluate whether DDAVP reduced bleeding complications after percutaneous kidney biopsies. METHODS We searched CENTRAL, PubMed, Embase, LILACS, WHO Trials Registry and ClinicalTrials.gov until May 2019 for randomised controlled trials (RCTs), quasi-RCTs and prospective cohort studies that compared DDAVP with placebo or no intervention, prior to native or allograft kidney biopsy. The primary outcome was post-biopsy bleeding. Secondary outcome was adverse events related to DDAVP. RESULTS Abstracts of 270 identified papers were examined and 24 selected for evaluation. Two studies, one RCT and one prospective cohort that collectively evaluated 738 native kidney biopsies, met the inclusion criteria. One enrolled individuals with serum creatinine ≤1.5 mg/dL (132 mumol/L) and/or eGFR ≥60 ml/min/1.73 m(2) while the other evaluated biopsies with serum creatinine >150 mumol/L. DDAVP was administered as a single subcutaneous dose of 0.3 mug/kg in both studies. Data were not pooled for meta-analysis due to clinical heterogeneity. GRADE quality of evidence from these two studies was low for DDAVP preventing any bleeding complication after native kidney biopsy. Low quality evidence suggested that adverse effects were not increased in DDAVP therapy. No prospective studies evaluated DDAVP in transplant kidney biopsies. CONCLUSIONS Currently available prospective data is insufficient to support the routine use of DDAVP prior to percutaneous kidney biopsies hence high quality trials are required. This article is protected by copyright. All rights reserved.