Department of Renal Medicine, Singapore General Hospital, Academia Level 3, 20 College Road, Singapore, 169856, Singapore.
Pharmacy, Singapore General Hospital, 1 Hospital Drive, Outram Road, Singapore, Singapore.
Int Urol Nephrol. 2019 Jun;51(6):995-1004. doi: 10.1007/s11255-019-02155-9. Epub 2019 Apr 26.
Desmopressin is used to reduce bleeding complications for kidney biopsies with azotemia but little is known about desmopressin-induced hyponatremia in these individuals. We aimed to evaluate the impact of desmopressin prophylaxis on severe hyponatremia and bleeding after kidney biopsies in individuals with renal impairment.
This is a single-center retrospective cohort study of consecutive adults with serum creatinine ≥ 150 µmol/L and had ultrasound-guided percutaneous native or transplant kidney biopsies between June 2011 and July 2015. Data were retrieved from electronic medical records. Primary outcomes were the use of desmopressin prophylaxis and severe hyponatremia (serum sodium ≤ 125 mmol/L) within 7 days post-biopsy. Secondary outcome was post-biopsy bleeding.
240 native kidney and 196 allograft biopsies were performed. Median age was 51 (IQR 42.3, 60) years and eGFR was 21.9 (12.9, 30.1) ml/min/1.73 m. Although patients prescribed desmopressin prophylaxis (n = 226) had higher serum creatinine [279 (201, 392) vs. 187 (160, 241), p < 0.001], bleeding (15.0% vs. 13.3%, p = 0.60) was not significantly different with and without desmopressin. Severe hyponatremia occurred in 30 biopsies (6.9%) with nadir serum sodium level of 122 (119, 124) mmol/L at 3 (2, 5) days after biopsy, more frequently among those with desmopressin prophylaxis (10.7% vs. 3.0%, p = 0.002). Multi-variate analysis found that pre-biopsy serum sodium level [adjusted OR 0.80 (95% CI 0.72, 0.90), p < 0.001] and desmopressin prophylaxis [adjusted OR 4.02 (95% CI 1.58, 10.21), p = 0.003] were independently associated with severe hyponatremia after kidney biopsy.
Pre-biopsy desmopressin was associated with severe hyponatremia in individuals with renal impairment; hence, susceptible patients given desmopressin should be closely monitored.
去氨加压素可减少伴有氮质血症的肾活检出血并发症，但对于肾功能损害患者使用去氨加压素预防后发生严重低钠血症的情况知之甚少。本研究旨在评估去氨加压素预防对伴有肾功能损害的患者肾活检后严重低钠血症和出血的影响。
这是一项单中心回顾性队列研究，纳入了 2011 年 6 月至 2015 年 7 月期间接受超声引导下经皮肾活检或移植肾活检的血清肌酐≥150μmol/L 的连续成年患者。数据从电子病历中提取。主要结局为活检后 7 天内使用去氨加压素预防和严重低钠血症（血清钠≤125mmol/L）。次要结局为活检后出血。
共进行了 240 例肾活检和 196 例移植肾活检。中位年龄为 51（IQR 42.3，60）岁，估算肾小球滤过率（eGFR）为 21.9（12.9，30.1）ml/min/1.73m。虽然使用去氨加压素预防的患者（n=226）血清肌酐更高[279（201，392）vs. 187（160，241），p<0.001]，但使用和未使用去氨加压素的患者出血（15.0% vs. 13.3%）无显著差异（p=0.60）。30 例（6.9%）发生严重低钠血症，活检后 3（2，5）天血清钠最低值为 122（119，124）mmol/L，去氨加压素预防组更常见（10.7% vs. 3.0%，p=0.002）。多变量分析发现，活检前血清钠水平[校正比值比（OR）0.80（95%CI 0.72，0.90），p<0.001]和去氨加压素预防[校正 OR 4.02（95%CI 1.58，10.21），p=0.003]与肾活检后严重低钠血症独立相关。
在伴有肾功能损害的患者中，活检前使用去氨加压素与严重低钠血症相关，因此，给予去氨加压素预防的易感患者应密切监测。
