Intranasal desmopressin cuts renal biopsy-related bleeding complications

Administering intranasal desmopressin to patients with renal dysfunction not requiring haemodialysis reduces bleeding complications during renal biopsies, especially minor complications such as perinephric haematomas, a study has found. However, it may increase the risk of incident hyponatraemia.

The study involved 194 nondialysis patients with serum creatinine >132.6 μmol/L and undergoing ultrasound-assisted needle-guided renal biopsy. Of these patients, 105 received 150 μg of desmopressin (D-amino D-arginine vasopressin (DDAVP)) while 89 did not.

Overall and minor bleeding complications occurred less frequently in the treated vs untreated group (15.7 percent vs 31.4 percent and 14 percent vs 27 percent, respectively), as did perinephric haematomas (7.8 percent vs 19 percent; p-all<0.05).

In multivariate logistic regression models, nonuse of desmopressin and female sex emerged as significant predictors of overall risk of bleeding.

However, serum sodium levels dropped in 94 percent of patients treated with desmopressin. Factors associated with greater decrease in serum sodium after treatment were higher estimated glomerular function rate and higher spot urine sodium values.

Researchers explained that a combination of diuretics or renin–angiotensin system (RAS) inhibitors and desmopressin should precipitate hyponatraemia in light of the drugs’ combined effects of salt wasting and water conservation. However, there was no evidence of any positive association between the use of these drugs and the development of hyponatraemia in the study.

The lack of evidence could be attributed to gating or breaking effects due to the continued use of diuretics or intrinsic tubular resistance due to the effects of these drugs, the researchers pointed out. “Nevertheless, as the dose and duration of diuretics and RAS inhibitors were not standardized for all the patients, a role for these drugs in the subsequent development of hyponatraemia cannot be denied based on this study.”