Pre-procedure desmopressin acetate to reduce bleeding in renal failure: does it really work?
BACKGROUND
Desmopressin (DDAVP) is often used prior to procedures to minimize bleeding in patients with renal failure; however, there is little evidence to support this practice. The objectives of this study were to evaluate the practice of administration of DDAVP prior to procedures within our division and to determine the number of bleeding episodes for patients who received DDAVP compared to those who did not.


METHODS
Hospital records of patients who underwent renal biopsy or central line placement between April 2006 and March 2008 were reviewed. Patients with glomerular filtration rate (GFR) <60 ml/min/1.73 m(2) were identified and subcategorized into three groups: group A GFR <15 ml/min/1.73 m(2), group B GFR 15-29 ml/min/1.73 m(2), and group C GFR 30-60 ml/min/1.73 m(2). The number of bleeding events was noted in each group.


RESULTS
No significant difference was found in the number of bleeding events between those who received and did not receive DDAVP overall and in each GFR group. A possible trend towards the benefit with treatment in group A was observed.


CONCLUSIONS
There was no significant reduction in bleeding for those who received DDAVP which questions the validity of this practice. Patients with GFR <15 ml/min/1.73 m(2) may possibly derive benefit.
Division of Nephrology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ont., Canada.
Seetha
S
Radhakrishnan
Rahul
R
Chanchlani
Bairbre
B
Connolly
Valerie
V
Langlois
D001706:Biopsy; D002405:Catheterization, Central Venous; D002648:Child; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000517:prevention & control*; D011292:Premedication; D011300:Preoperative Care; D051437:Renal Insufficiency / Q000150:complications*; D012189:Retrospective Studies; D016896:Treatment Outcome
D006490:Hemostatics; D003894:Deamino Arginine Vasopressin