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. 2020 Mar 4;5(4):511-518.
doi: 10.1016/j.ekir.2020.01.012. eCollection 2020 Apr.

Bleeding Complications After Percutaneous Native Kidney Biopsy: Results From the Boston Kidney Biopsy Cohort

Ragnar Palsson  1   2 , Samuel A P Short  1 , Zoe A Kibbelaar  1   3 , Afolarin Amodu  1   3 , Isaac E Stillman  4 , Helmut G Rennke  5 , Gearoid M McMahon  1 , Sushrut S Waikar  1   3
Affiliations

Bleeding Complications After Percutaneous Native Kidney Biopsy: Results From the Boston Kidney Biopsy Cohort

Ragnar Palsson et al. Kidney Int Rep. .

Abstract

Background: The major risk of kidney biopsy is severe bleeding. Numerous risk factors for bleeding after biopsy have been reported, but findings have been inconsistent.

Methods: We retrospectively reviewed medical records of adult patients enrolled in a native kidney biopsy cohort study to identify major bleeding events (red blood cell [RBC] transfusions, invasive procedures, kidney loss, or death). We used logistic and linear regression models to identify characteristics associated with postbiopsy RBC transfusions and decline in hemoglobin within a week after the procedure.

Results: Major bleeding events occurred in 28 of 644 (4.3%) patients (28 required an RBC transfusion, 4 underwent angiographic intervention, and 1 had open surgery to control bleeding). No patient lost a kidney or died because of the biopsy. Postbiopsy RBC transfusion risk was driven by the baseline hemoglobin level (odds ratio [OR] 13.6; 95% confidence interval [CI] 5.4-34.1 for hemoglobin <10 vs. ≥10 g/dl). After adjusting for hemoglobin, no other patient characteristics were independently associated with RBC transfusions. Female sex (β = 0.18; 95% CI: 0.04-0.32), estimated glomerular filtration rate (eGFR) <30 ml/min per 1.73 m2 (β = 0.32; 95% CI: 0.14-0.49), and baseline hemoglobin (β = 0.09; 95% CI: 0.05-0.13, per g/dl increase) were independently associated with a larger drop in hemoglobin. Histopathologic lesions were not independently associated with major bleeding after biopsy.

Conclusion: Biopsies were generally well tolerated. Baseline hemoglobin was the dominant risk factor for RBC transfusions, but female sex and eGFR <30 ml/min per 1.73 m2 were also associated with a larger decline in hemoglobin after the procedure.

Keywords: biopsy; bleeding; blood transfusions; kidney diseases; risk factors.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Distribution of baseline hemoglobin and estimated glomerular filtration rate (eGFR) among patients in the cohort. Red diamonds represent individuals who received a red blood cell transfusion after biopsy, black triangles represent those who were not transfused but developed a hematoma postbiopsy, and blue boxes represent those in which neither of these events occurred. The vertical dotted line marks the hemoglobin level of 10 g/dl and the horizontal dotted line marks the eGFR level of 30 ml/min per 1.73 m2.
Figure 2
Figure 2
Of 644 patients included in the analysis, 28 (4.3%) required a red blood cell transfusion after undergoing percutaneous native kidney biopsy; 4 (0.6%) required angiographic intervention and 1 (0.2%) subsequently underwent open surgery to control bleeding. No patients lost a kidney or died because of the procedure.
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