Routine haemostasis testing before transplanted kidney biopsy: a cohort study

Kuiper, Gerhardus J.A.J.M.; Christiaans, Maarten H. L.; Mullens, M; Cate, Hugo Ten; Hamulyák, Karly; Henskens, Yvonne

doi:10.1111/tri.13090

Cited by 4 publications

(9 citation statements)

References 39 publications

(64 reference statements)

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“…After the removal of duplicates, 5004 unique records were identified, of which 4814 records were excluded after the screening of titles and abstracts. Of the 190 remaining studies, 72 studies (40 082 biopsies) 2,3,9,14,25-92 were included in the systematic review and meta-analysis after full-text review (Figure 1) including 4 single-center randomized controlled trials, 3 multicenter cohort studies (1 mixed retrospective-prospective and 2 retrospective), and 65 single-center cohort studies (10 prospective, 1 mixed retrospective-prospective, 46 retrospective, and 8 unreported). Details of the included studies are presented in Table S1, SDC, http://links.lww.com/TP/C332.…”

Section: Resultsmentioning

confidence: 99%

Complications of Percutaneous Kidney Allograft Biopsy: Systematic Review and Meta-analysis

Lim

Tan

et al. 2022

Transplantation

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Background. Kidney biopsy is important to guide the management of allograft dysfunction but has a risk of complications. This review aimed to determine the incidence and risk factors of complications after kidney allograft biopsy. Methods. This is a systematic review and meta-analysis of randomized controlled trials, cohort studies, or case-control studies indexed on PubMed, Embase, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry, and ClinicalTrials.gov, limited to the English language, from January 2000 to December 2020, including adult and pediatric kidney allograft biopsies. Primary outcomes were gross hematuria, bleeding requiring transfusion, and major complications (requiring interventions such as blood transfusion or surgical or radiological interventions). Results. The review included 72 studies (40 082 biopsies). The quality of included studies was suboptimal. Pooled rates of gross hematuria, bleeding requiring transfusion, and major complications were 3.18% [95% confidence interval (95% CI), 2.31-4.19], 0.31% (95% CI, 0.15-0.52) and 0.89% (95% CI, 0.61-1.22), respectively. Gross hematuria rates were lower in high-income compared with middle-income countries (2.59% versus 6.44%, P < 0.01) and biopsies performed by radiology as compared with nephrology departments (1.25% versus 3.71%, P < 0.01). Blood transfusion rates were lower in pediatrics than adults (0.0% versus 0.65%, P < 0.01). Major complications were lower in biopsies performed by specialists as compared with trainees (0.02% versus 3.64%, P < 0.01). Graft loss and mortality were extremely rare. Limitations included missing data, few randomized controlled trials, and possible publication bias. Conclusions. The risk of complications after kidney allograft biopsy was low. Given the low quality of included studies, risk factors for complications should be further examined in future studies.

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Section: Resultsmentioning

confidence: 99%

Complications of Percutaneous Kidney Allograft Biopsy: Systematic Review and Meta-analysis

Lim

Tan

et al. 2022

Transplantation

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“…Platelet function analyzer-100 (PFA-100) test measures activated platelets and is more sensitive in comparison with the bleeding time for bleeding disorders. However, it was not found to be useful in predicting bleeding post kidney biopsy [25,26].…”

Section: Introductionmentioning

confidence: 94%

Thromboelastography versus bleeding time for risk of bleeding post native kidney biopsy

et al. 2019

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Introduction: The risk of bleeding has led to screening of the primary hemostasis before renal biopsy. A bleeding time test (BT) is considered standard practice, but reliance on this test is controversial and its benefits remain questionable. A possible alternative is thromboelastography (TEG). However, data regarding TEG in patients with renal dysfunction is limited. Objectives: To determine TEG abnormalities and their consequences in patients who underwent a native kidney biopsy. Methods: A retrospective study of 417 consecutive percutaneous native renal biopsies performed in our Center. If serum creatinine >1.5 mg/dL, the patient underwent either a BT test (period A, January 2015-31 December 2016) or TEG (period B, January 2017-August 2018). In patients with prolonged BT, or an abnormal low maximal amplitude (MA) parameter of TEG, or suspected clinical uremic thrombopathy, the use of desmopressin acetate (DDAVP) was considered. Results: Most biopsies (90.6%) were done by the same dedicated radiologist. Fifty-one patients had a BT test, which was normal in all tested patients. Seventy-one patients underwent TEG, and it was abnormal in 34 of them, most patients had combined abnormalities. The only parameter related to abnormal TEG was older age (Odds Ratio 1.21 [95% CI 1.09-2.38] p ¼ 0.04 for abnormal Kinetics; OR 1.37 (1.05-1.96) p ¼ 0.037 for abnormal MA). Twenty-six patients (6.23%) had bleeding complications. Risk of bleeding was significantly related to age (1.4 [1.11-7.48] p ¼ 0.04), systolic blood pressure (1.85 [1.258-9.65] p ¼ 0.02), and serum creatinine (1.21 [1.06-3.134] p ¼ 0.048). Conclusions: TEG abnormalities in patients with renal dysfunction are variable and fail to predict bleeding during kidney biopsy. The decision to administer DDAVP as a preventive measure during these procedures should be based on clinical judgment only.

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“…All studies were observational cohort studies, and only two were prospective in nature. 18,20 The definition used for aspirin exposure was disparate. While some studies limited valid aspirin exposure to a confirmed dose the same day as the kidney biopsy, others had broader criteria that included patients with any confirmed dose within 10 days of the intervention.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…1,[3][4][5][6] Despite advancements in the technique and equipment, major hemorrhagic complications are still responsible for lengthier hospital stays and increased treatment costs, 6,7 occurring in 0.24%-6.6% of all patients subjected to kidney biopsies. 2,4,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Various factors have been associated with increased biopsy complication rates, including unmodifiable factors, such as age and sex, comorbidities (high serum creatinine levels, obesity, anemia, systemic autoimmune diseases, amyloidosis), and procedure-associated aspects. 2,[5][6][7]10,[23][24][25] Most centers have similar safety requirements, with universal consensus regarding the need for adequate blood pressure control and correction of any preexisting coagulopathy.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Aspirin on Kidney Biopsy Bleeding Complications: A Systematic Review and Meta-Analysis (PROSPERO 2021 CRD42021261005)

et al. 2023

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Postprocedural bleeding is the main complication of percutaneous kidney biopsy (PKB). Therefore, aspirin is routinely withheld in patients undergoing PKB to reduce the bleeding risk. The authors aimed to examine the association between aspirin use and bleeding during PKB. This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The article search was performed on MEDLINE and Scopus using queries specific to each database. Article inclusion was limited to primary studies. The meta-analysis compared the risk of major bleeding events between the aspirinexposed versus nonexposed group. Pooled effect estimate was examined using random effects presented as odds ratio with 95% confidence intervals. Heterogeneity was assessed through Cochrane I 2 test statistics. Sensitivity and subgroup analyses were also performed according to kidney type. Ten studies were included in the review and four studies were included in the meta-analysis, reviewing a total of 34,067 PKBs. Definitions for significant aspirin exposure were inconsistent between studies, limiting comparisons. Studies with broader definitions for aspirin exposure mostly showed no correlation between aspirin use and postbiopsy bleeding. Studies with strict definitions for aspirin exposure found an increased risk of hemorrhagic events in the aspirin-exposed group. No significant differences were found between the aspirin-exposed and comparison groups regarding major bleeding events (odds ratio 1.72; 95% confidence interval 0.50 to 5.89, I 2 584%). High-quality evidence on the effect of aspirin on the bleeding risk is limited. Our meta-analysis did not show a significantly increased risk of major bleeding complications in aspirin-exposed patients. Further studies are needed to define a more comprehensive approach for clinical practice.

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Routine haemostasis testing before transplanted kidney biopsy: a cohort study

Cited by 4 publications

References 39 publications

Complications of Percutaneous Kidney Allograft Biopsy: Systematic Review and Meta-analysis

Complications of Percutaneous Kidney Allograft Biopsy: Systematic Review and Meta-analysis

Thromboelastography versus bleeding time for risk of bleeding post native kidney biopsy

Effects of Aspirin on Kidney Biopsy Bleeding Complications: A Systematic Review and Meta-Analysis (PROSPERO 2021 CRD42021261005)

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