Kidney Week

Abstract: SA-PO050

Bleeding Complications after Native Kidney Biopsy Associated with Aspirin Use

Session Information

• AKI: Clinical, Outcomes, and Trials - Management
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Menez, Steven, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Steven Menez, MD

• Hu, David, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

David Hu, MS

• Thiessen Philbrook, Heather, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Heather Thiessen Philbrook

• Bitzel, Jack, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Jack Bitzel

• Wen, Yumeng, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Yumeng Wen, MD, PhD

• Atta, Mohamed G., The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Mohamed G. Atta, MD, MPH, FASN

• Srialluri, Nityasree, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Nityasree Srialluri, MD, MS

• Sperati, John, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

John Sperati, MD

• Jaar, Bernard G., The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Bernard G. Jaar, MD, MPH, FASN

• Corona Villalobos, Celia Pamela, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Celia Pamela Corona Villalobos, MD, MS

• Shelton, Kyra A., Yale University School of Medicine, New Haven, Connecticut, United States

Kyra A. Shelton

• Makhijani, Amrita, Yale University School of Medicine, New Haven, Connecticut, United States

Amrita Makhijani

• Moledina, Dennis G., Yale University School of Medicine, New Haven, Connecticut, United States

Dennis G. Moledina, MD, PhD, FASN

• Parikh, Chirag R., The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Chirag R. Parikh, MD, PhD, FASN

Background

Bleeding complications following native kidney biopsy include a drop in hemoglobin (Hgb) and the need for blood transfusion. Anti-platelet agents such as aspirin are often discontinued for 7 days pre-biopsy, and this washout period can lead to delays in diagnosis and clinical decision-making. We explored the association of aspirin exposure pre-biopsy with post-biopsy bleeding complications.

Methods

Among adult patients receiving native kidney biopsies at the Johns Hopkins Hospital (JHH) between 2019-2022, and at Yale University Hospital between 2015-2018, aspirin exposure was categorized by last documented use pre-biopsy. Outcomes included a Hgb drop within 3 days and packed red blood cell (pRBC) transfusion within 7 days post-biopsy. Logistic regression was used to determine the odds of these complications by aspirin use, adjusting for pre-biopsy Hgb and platelet count. We adjudicated relatedness of pRBC transfusion to kidney biopsy in a subset of patients.

Results

At JHH, last aspirin use within 3 days pre-biopsy was not significantly associated with higher risk of Hgb drop ≥ 1 g/dL (aOR 1.51; 95% CI: 0.90-2.51) compared to patients with no prior aspirin use within a year. The overall incidence rates of pRBC transfusion were 126/711 (18%) and 33/166 (20%) at JHH and Yale respectively. There was no significant increase in the odds of pRBC transfusion by timing of aspirin discontinuation. In a sub-cohort of 166 patients at JHH, after adjudication, only 8 (4.8%) were deemed to be biopsy-related. Similar results were seen at Yale.

Conclusion

Aspirin exposure pre-biopsy was not associated with increased odds of significant bleeding complications, with biopsy-related pRBC transfusion between 5-8%. These risks should be discussed when consenting patients where urgent biopsy diagnosis is necessary for timely therapeutic decision-making.