Heterogeneity in Randomized Clinical Trials Regarding Desmopressin Use Before Kidney Biopsy to Prevent Bleeding

Background: Several randomized clinical trials have evaluated desmopressin in patients with reduced kidney function undergoing biopsy. Conflicting results may stem from heterogeneity in study design. We conducted a comparative analysis of methodologies across all existing RCTs on desmopressin use in this context. Methods: We conducted a comprehensive literature search to identify all randomized controlled trials (RCTs) evaluating desmopressin as a hemostatic agent in patients undergoing kidney biopsy. Searches were performed in Medline, Embase, and the Cochrane Central Register of Controlled Trials from database inception through May 2025. Eligible RCTs were assessed for key methodological and reporting characteristics, including sample size, study location, desmopressin dose and route of administration, comparator group, baseline estimated glomerular filtration rate (eGFR), and incidence of post-biopsy hematoma. Results: 5 RCTs were identified (Table 1). Most trails had small patient size (< 200) with only one enrolling 203 patients. Dosing, route (mostly intranasal), and baseline eGFR varied across studies. Control arms also differed (often intranasal saline). Manno (2011) and Prasad (2025) showed reduced bleeding/hematomas; Sethi (2024) and Chakrabarti (2025) found no clear benefit in low eGFR. Sattari (2022) reported safety and efficacy across eGFR levels. Efficacy appears context-dependent, influenced by renal function, dose, and route. Hyponatremia was noted in some studies, likely from water retention; others didn’t report sodium levels. Conclusion: RCTs on desmopressin before kidney biopsy in reduced kidney function showed heterogeneity in design, dosing, route, controls, and eGFR. Results were mixed; benefit appears context dependent. Hyponatremia reporting was inconsistent. Future trials need standard dosing, clear eGFR cutoffs, consistent outcomes, and routine safety checks to clarify desmopressin’s role. Table 1 - Name and Year Country No. of patients Route of administration of Desmopressin Dose administered Control eGFR Primary Outcome Safety Manno et al, 2011 Italy 162 Subcutaneous (S/C) 0.3 μg/kg S/C saline ≥60 mL/min/1.73 m2 Bleeding complications: 13.7% (desmopressin) vs. 30.5% (control), P=0.01 Smaller hematoma size: 208 mm2 (desmopressin) vs. 380 mm2 (control), P=0.006 No serious adverse events Mild transient tachycardia in 3 patients Sattari et al, 2022 Iran 120 Intranasal 3 μg/kg Intranasal NaCl 0.65% 15-90 mL/min/1.73 m2 Hematoma incidence: 11.6% (desmopressin) vs. 40% (control), P < 0.05 Smaller hematoma volume: 2.31 mm3 (desmopressin) vs. 7.72 mm3 (control), P < 0.05 No major adverse events No significant hyponatremia or blood pressure changes Sethi et al, 2024 India 80 Intranasal 150 μg/kg Intranasal saline 20.82 mL/min/1.73 m2 More minor bleeding with desmopressin: 17.5% vs. 2.5% (P = 0.02) No significant reduction in major complications: 7.5% (desmopressin) vs. 0% (control), P = 0.15 No significant difference in hypotension, flushing, and vasovagal syncope Chakrabarti et al, 2025 India 152 Intranasal 3 μg/kg Intranasal saline ≤ 60 mL/min/1.73 m2 Bleeding: 36% (desmopressin) vs. 47% (control), P = 0.17 Lower hematoma frequency at 24h: 19% (desmopressin) vs. 36% (control), P = 0.02 Asymptomatic hyponatremia No difference in major complications (transfusion/embolization) Prasad et al, 2025 India 203 Intranasal 300 μg/kg Intranasal saline > 30 mL/min/1.73 m2 (n =102) and < 30 mL/min/1.73 m2 (n = 101) Bleeding: 11.9% (desmopressin) vs. 33.3% (control), P = 0.0003 Hematoma formation: 11.9% (desmopressin) vs. 30.4% (control), P = 0.001 Nasal discomfort: 28.7% (desmopressin) vs. 5.8% (control) Headache: 7.9% (desmopressin) vs. 1.9 (control) Transient hyponatremia