Major Bleeding of Transjugular Native Kidney Biopsies. A French Nationwide Cohort Study

Abstract

Introduction: The risk of bleeding associated with transjugular kidney biopsies is unclear, and which patients are the best candidates for this route is unknown.

Methods: This was a retrospective cohort study comparing proportion of bleeding associated with transjugular versus percutaneous native kidney biopsies in all patients in France in the 2010-2019 period. Major bleeding at day 8 (i.e., blood transfusions, hemorrhage/hematoma, angiographic intervention, nephrectomy) and risk of death at day 30 were assessed, and we used a bleeding risk score initially developed for the percutaneous route.

Results: Our analysis included 60,331 patients (transjugular route: 5305; percutaneous route: 55,026 patients). The observed proportion of major bleeding varied widely (transjugular vs. percutaneous): 0.4% versus 0.5% for the lowest risk scores (0-4) to 19.1% versus 30.8% for the highest risk scores (≥35). Transjugular was more frequently used than percutaneous route (39% vs. 24%) when the risk score was ≥20 (15,133/60,331; 25% of all patients). Transjugular was associated with a lower risk of major bleeding than percutaneous route in multivariate analyses (odds ratio [OR]: 0.88 [0.78-0.99]), especially for scores ≥20 (OR: 0.83 [0.72-0.96], (i.e., 25% of patients). Major bleeding was associated with an increased risk of death both for transjugular (OR: 1.77 [1.00-3.14]) and percutaneous (OR: 1.80 [1.43-2.28]) routes.

Conclusions: The transjugular route is independently associated with a lower risk of bleeding than the percutaneous route, especially in high-risk patients identified by a preprocedure risk score ≥20 (i.e., 25% of patients). Major bleeding is associated with an increased risk of death for both routes.

Keywords: bleeding score; epidemiology; kidney biopsy; percutaneous; transjugular.

Graphical abstract

Figure 1

Major bleeding risk score receiver operating characteristic (ROC) curve. ROC curves are presented using the continuous score (a) and the 8-level score (b). Area under curve (AUC) of the bleeding risk score was good in patients with transjugular kidney biopsies but was significantly lower than in patients with percutaneous kidney biopsies (continuous score: 0.750 [0.727–0.774] vs. 0.801 [0.793–0.808], P < 0.001); 8-level score: 0.746 [0.723–0.770] vs. 0.793 [0.786–0.801], P < 0.001).

Figure 2

(a) Proportion of patients who had a transjugular versus a percutaneous kidney biopsy according to the preprocedure bleeding risk score. The proportion of transjugular versus percutaneous kidney biopsy is shown in relation to the number of points of the bleeding risk score (from 0–4 to ≥35). The distribution of the route of biopsy (transjugular vs. percutaneous) differed according to the bleeding risk. The percentages of transjugular versus percutaneous kidney biopsy according to the risk score were 4.4% versus 10.1% (score = 0–4); 17.6% versus 27.7% (score = 5–9); 18.2%–21.7% (score = 10–14); 20.7% vs. 16.9% (score = 15–19); 16.6% vs. 11.4% (score = 20–24); 14.1% vs. 8.5% (score = 25–29); 7.7% vs. 3.5% (score = 30–34); 0.8% vs. 0.4% (score ≥35) (P < 0.001). (b) Proportion of major bleeding according to preprocedure bleeding risk score. The proportion of major bleeding (blood transfusion, hemorrhage/hematoma, angiography intervention, or nephrectomy) is shown in relation to the number of points of the preprocedure bleeding risk score (from 0–4 to ≥35) in patients with transjugular and percutaneous kidney biopsy. The proportion of major bleeding was significantly lower in transjugular than in percutaneous kidney biopsy for score ≥20: 9.2% versus 13.5% (score = 20–24); 16.8% versus 19.8% (score = 25–29); 22.5% versus 30.2%; (score = 30–34); 23.5% versus 44.4% (score ≥35) (overall P < 0.001). For lower scores, the proportion of major bleeding was similar in the 2 groups (0.4% vs. 0.5% [score = 0–4]; 1.2% vs. 1.2% [score = 5–9]; 2.1% vs. 2.5% [score = 10–14]; 5.5% vs. 5.3% [score = 15–19]).