Efficacy of Desmopressin for Post‐Kidney Biopsy Bleeding Complications Prevention: A Systematic Review With Frequentist and Bayesian Meta‐Analysis

ABSTRACT Aim Desmopressin was hypothesised to prevent post‐kidney biopsy bleeding; however, its efficacy in reducing bleeding and bleeding‐related complications has yet to be systematically examined. Methods Relevant studies from online electronic databases up to 15 May 2025 were identified. Randomised controlled trials (RCT) reporting the efficacy of desmopressin for prevention of adult post‐kidney bleeding complications were included. A random‐effect meta‐analysis, trial sequential analysis and Bayesian meta‐analysis were conducted. We assessed the certainty of the evidence (CoE) by using the GRADE methodology. Results Seven RCTs comprising 827 participants were included. By analysis of all seven studies, desmopressin shows a trend of reducing all post biopsy bleeding events (risk ratio [RR] = 0.77, 95% CI = 0.37–1.59) with very low CoE. In a sensitivity analysis excluding an outlier trial, desmopressin was associated with a lower risk of any bleeding and reduced heterogeneity (RR = 0.56, 95% CI = 0.39–0.80; I 2 = 56%; moderate CoE). Desmopressin did not reduce post biopsy gross hematuria (RR: 1.00, 95% CI: 0.42–2.36), severe bleeding needs blood transfusion (RR = 1.46, 95% CI = 0.66–3.23), or invasive intervention (RR = 1.39, 95% CI = 0.38–5.09). A Bayesian analysis estimated a 76% posterior probability of any benefit, although the 95% credible interval indicated imprecision. Desmopressin is also associated with an RR of 4.52 (95% CI = 2.05–9.94; I 2 = 0.0%) for hyponatremia. Conclusion Desmopressin may reduce overall bleeding after kidney biopsy; however, low‐certainty evidence and imprecise estimates are noted, necessitating further large‐scale studies to explore its potential benefit, particularly in high‐risk populations.