Desmopressin and Its Role in Postkidney Biopsy Bleeding Risks: A Systematic Review and Meta-Analysis

Background: Percutaneous renal biopsy is a key diagnostic tool in nephrology but carries a risk of post-procedure bleeding, with complications ranging from minor hematomas to life-threatening hemorrhages. Desmopressin (DDAVP), a synthetic vasopressin analogue, has been utilized as a prophylactic agent to reduce the risk of bleeding by enhancing von Willebrand factor and factor VIII activity. Existing systematic reviews lack a cumulative synthesis of efficacy data. Hence, this systematic review and meta-analysis aims to resolve uncertainties regarding the role of desmopressin in renal biopsy care in diverse cohorts, informing evidence-based practice. Methods: A systematic search was performed on PubMed, Web of Science, Scopus, Cochrane Library, and ClinicalTrials.gov from inception to May 2025 for randomized controlled trials that compared Desmopressin with placebo before native kidney biopsy. The outcome focused on post-biopsy bleeding and its related individual complications. Results: A total of five randomized controlled trials (RCTs), including 717 patients undergoing renal biopsy, were included in our study. Desmopressin was associated with a significant reduction in total bleeding events compared to placebo (RR 0.51, 95% CI [0.31, 0.83], P = 0.008). Additionally, desmopressin was associated with a lower rate of hematoma formation compared to placebo (RR 0.60, 95% CI [0.30, 1.19], P = 0.15), although this difference was not statistically significant. However, there were no significant differences between the two groups regarding gross hematuria (RR 1.03, 95% CI [0.40, 2.63], P = 0.95), need for blood transfusion (RR 1.64, 95% CI [0.71, 3.78], P = 0.25), or requirement for interventional procedures (RR 1.85, 95% CI [0.40, 8.56], P = 0.43) or change in Hemoglobin Level (MD -0.06, 95% CI [-0.21, 0.09],P<0.44). Conclusion: This meta-analysis suggests that desmopressin significantly reduces the overall risk of bleeding but does not have a significant impact on specific bleeding-related complications. However, further large-scale, high-quality trials are necessary to confirm these findings and establish long-term efficacy.