FP147DESMOPRESSIN USE AND HYPONATREMIA IN PATIENTS WITH RENAL IMPAIRMENT UNDERGOING PERCUTANEOUS ULTRASOUND-GUIDED KIDNEY BIOPSIES

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INTRODUCTION AND AIMS: Bleeding risk in kidney biopsies may be exacerbated by uremia-mediated platelet dysfunction but potentially reduced with pre-biopsy desmopressin. However, few centers have reported prevalence and desmopressin-induced hyponatremia after native and transplant allograft kidney biopsy. We aimed to evaluate the use of desmopressin for prophylaxis against post-kidney biopsy bleed and incidence of post-biopsy hyponatremia. METHODS: Single center retrospective study of consecutive adults ≥21 years with baseline serum creatinine ≥150 µmol/L and had percutaneous ultrasound-guided biopsy of either a native and transplant kidney between 1st June 2011 and 31st July 2015. All patients were admitted and routinely observed for at least 24 hours post-biopsy. Biopsies were performed under direct ultrasound guidance with 16 or 18-gauge automated spring-loaded biopsy guns. Demographic and clinical data were retrieved from electronic medical records. Outcomes of interest were use of desmopressin prophylaxis and severe hyponatremia, defined by post-biopsy serum sodium ≤125 mmol/L, within 7 days after kidney biopsy. RESULTS: We evaluated 438 kidney biopsies (242 native, 196 allograft) where median age at biopsy was 51 (IQR: 42, 60) years, 57% male and the following co-morbid: hypertension 82%, SBP 130 (120, 143) mmHg, serum urea 13.0 (9.6, 16.9) mmol/L, serum creatinine 225 (170, 324) µmol/L and CKD EPI eGFR 21.9 (12.9, 30.1) ml/min/1.73 m2. Desmopressin prophylaxis was administered in 226 biopsies (128 native, 98 allograft). Patients with urea >15 mmol/L (52.2% vs. 15.2%, p<0.001), eGFR <30 ml/min/1.73 m2 (89.8% vs. 57.6%, p<0.001), lower hemoglobin level (10.4 ± 1.7 vs. 11.5 ±2.2 g/dL, p<0.001) and on loop diuretic (43.8% vs. 26.2%, p<0.001) were more commonly administered desmopressin prophylaxis. Post -biopsy serum sodium levels were available in 423 biopsies. Severe hyponatremia occurred in 30 episodes at 2 (1, 4) days after biopsy and was more frequent in the desmopressin group (10.7%) compared to those who did not receive desmopressin (3.0%, p=0.002). Logistic regression taking into account age, predisposing comorbidities (weight, congestive cardiac failure, liver cirrhosis, kidney transplant), biochemistry (pre-biopsy serum sodium, urea, eGFR, UPCR) and medications (diuretic, desmopressin dose) found that higher desmopressin dose was independently associated with severe hyponatremia after kidney biopsy [adjusted OR 1.43 (95% CI 1.03, 1.98), p=0.03]. CONCLUSIONS: Desmopressin dose was independently associated with severe hyponatremia hence susceptible patients given desmopressin prophylaxis, such as those on diuretic, should be dosed cautiously and monitored closely with a post-biopsy serum sodium.

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