Abstract
BACKGROUND: Desmopressin (DDAVP) is sometimes used prophylactically to mitigate bleeding complications associated with kidney biopsy in patients with impaired kidney function, although its efficacy remains uncertain. We conducted a systematic review and meta-analysis to evaluate whether DDAVP reduces bleeding complications in high-risk patients undergoing native kidney biopsy. METHODS: We searched PubMed, EMBASE, Cochrane, and ClinicalTrials.gov through April 2025 for randomized or observational studies comparing DDAVP to placebo or no intervention in adults with eGFR <60 mL/min/1.73 m(2). The primary outcome was overall bleeding. Pooled risk ratios (RRs) were estimated using a random-effects model. Subgroup and sensitivity analyses, including leave-one-out diagnostics, were performed. RESULTS: Nine studies (n = 2,470) were included. The pooled RR for bleeding was 0.61 (95% CI, 0.33-1.11), with substantial heterogeneity (I(2) = 73.6%). Observational studies showed a significant reduction in bleeding (RR = 0.52; 95% CI, 0.44-0.61; I(2) = 0%), whereas RCTs did not (RR = 0.87; 95% CI, 0.10-7.69; I(2) = 89.3%). Sensitivity analysis identified one outlier; its exclusion reduced heterogeneity (I(2) = 18.3%) and yielded a pooled effect (p < .0001). Safety outcomes were infrequently reported but appeared to be mild. CONCLUSIONS: While the overall pooled analysis did not reach statistical significance, results from observational studies and sensitivity analyses suggest a potential protective effect of DDAVP in reducing bleeding after kidney biopsy in high-risk patients. However, given the low certainty of evidence, these findings should be considered exploratory and hypothesis-generating. Larger, well-powered RCTs are warranted to confirm these findings and to better characterize safety.