Risk factors for bleeding complications after nephrologist-performed native renal biopsy

Abstract

BackgroundBleeding is a recognized complication of native percutaneous renal biopsy. This study aimed to describe the incidence of major bleeding after biopsy in a single centre over a 15-year period and examine factors associated with major bleeding.MethodsWe identified consecutive adult patients undergoing ultrasound-guided native renal biopsy in the Glasgow Renal and Transplant Unit from 2000 to 2014. From the electronic patient record, we collected data pertaining to biopsy indication, pre- and post-biopsy laboratory measurements, prescribed medication and diagnosis. Aspirin was routinely continued. We defined major bleeding post-biopsy as the need for blood transfusion, surgical or radiological intervention or death. Binary logistic regression analysis was used to assess factors associated with increased risk of major bleeding.ResultsThere were 2563 patients who underwent native renal biopsy (1499 elective, 1064 emergency). The average age of patients was 57 (SD 17) years and 57.4% were male. Overall, the rate of major bleeding was 2.2%. In all, 46 patients required transfusion (1.8%), 9 patients underwent embolization (0.4%), no patient required nephrectomy and 1 patient died as a result of a significant late retroperitoneal bleed. Major bleeding was more common in those undergoing emergency compared with elective renal biopsy (3.4 versus 1.1%; P < 0.001). Aspirin was being taken at the time of biopsy in 327 of 1509 patients, with no significant increase in the risk of major bleeding (P = 0.93). Body mass index (BMI) data were available for 546 patients, with no increased risk of major bleeding in 207 patients classified as obese (BMI >30).ConclusionsThe risk of major bleeding following native renal biopsy in the modern era is low. Complications are more common when biopsy is conducted as an emergency, which has implications for obtaining informed consent. Our data support the strategy of not stopping aspirin before renal biopsy.

Complications of Percutaneous Renal Biopsy

“…[13][14][15][16] A large retrospective review conducted by Lees et al examined 2,563 percutaneous renal biopsies performed over 15 years. 17 The rate of major bleeding was 2.2%, with 1.8% of patients requiring transfusion. Angiographic intervention was required in 0.4% of cases, and 0.04% of patients died.…”

“…The studies that have been conducted to determine if recent antiplatelet therapy prior to PRB is a risk factor for postbiopsy complications have been retrospective in nature, and no consensus regarding their periprocedural use has been reached. 17 Current Society of Interventional Radiology (SIR) recommendations are to hold aspirin and clopidogrel for 5 days prior to procedures with significant bleeding risk. 24 It is well known that patients with chronic renal disease have significant cardiovascular morbidity, and patients at risk for coronary artery disease have demonstrated a 3-fold increase of major adverse cardiac events after cessation of aspirin, and an 89-fold increase in patients with intracoronary stents.…”

“…24 It is well known that patients with chronic renal disease have significant cardiovascular morbidity, and patients at risk for coronary artery disease have demonstrated a 3-fold increase of major adverse cardiac events after cessation of aspirin, and an 89-fold increase in patients with intracoronary stents. 17,25 Additionally, these patients may have stents or grafts with a high risk of thrombosis that necessitates continuous antiplatelet therapy.…”

“…12 Another large series by Lees et al showed no significant increase in major complications based on whether aspirin or clopidogrel was held. 17 Baffour et al studied the effects of antiplatelet therapy on major complications in renal allograft biopsies and analyzed results based on amount of time antiplatelet therapy had been discontinued (0-3 vs. 4-7 vs. 8-10 days) and also found no statistically significant increase in major bleeding complications. There was, however, a sixfold increase in major complications seen in patients who had taken 325 mg of aspirin within 3 days of biopsy (OR, 6.3; 95% CI, 1.27-31.3).…”

“…7,12,[14][15][16] However, older patients who were biopsied in an emergent setting had an increased risk of major complications. 17…”