Objective To explore the incidence and risk factors of severe bleeding after percutaneous renal biopsy(PRB)in patients with advanced chronic kidney disease(CKD).Methods The study was a retrospective cohort analysis.The data were collected from patients with advanced CKD who were hospitalized in the Department of Nephrology,Nanfang Hospital,Southern Medical University and underwent PRB between January 2010 and December 2020.Severe bleeding after PRB was defined by any of the following criteria:a postoperative hemoglobin decrease of ≥20 g/L within 48 hours,a maximum diameter of perirenal hematoma ≥5 cm postoperatively,or the need for posterior pituitary hormone,blood transfusion,or renal vascular intervention post-surgery.The occurrence of severe bleeding following PRB served as the primary endpoint for this study.Logistic regression model was used to analyze the risk factors associated with severe bleeding in patients with advanced CKD undergoing PRB.Results A total of 895 patients aged(46.1±14.1)years were encompassed in the study.Among them,60.1％(538/895)were male,15.9％(142/895)were afflicted with diabetes,and 57.9％(518/895)suffered from hypertension.The estimated glomerular filtration rate(eGFR)was(40.1±13.2)ml·min-1·(1.73 m2)-1,and the 24-hour urine protein excretion was 2.5(1.1,4.9)g.After PRB,22.9％(205/895)of the patients encountered severe bleeding,including 30 patients(14.6％)who received postoperative somatostatin,10 patients(4.9％)who underwent postoperative blood transfusion,1 patient(0.5％)who underwent postoperative renal vascular intervention for hemostasis,and no fatalities occurred.Compared to the non-severe bleeding group,patients in the severe bleeding group after PRB exhibited a higher proportion of hypertension[64.4％(132/205)vs.55.9％(386/690),x2=4.627,P=0.031].Additionally,preoperative serum creatinine levels and mean arterial pressure were significantly elevated[(193.9±106.6)μmol/L vs.(180.8±102.6)μmol/L,t=-2.559,P=0.011;(95.8±10.9)mmHg vs.(93.9±11.0)mmHg,t=-2.134,P=0.033].Furthermore,platelet counts were lower in the severe bleeding group[(227.5±70.3)×109/L vs.(247.5±74.8)×109/L,t=-3.788,P＜0.001].No statistically significant differences were observed between the two groups regarding age,gender distribution,prevalence of diabetes mellitus,as well as preoperative serum albumin level,hemoglobin concentration,other coagulation function indicators and pathological histological type(all P＞0.05).Multivariate logistic regression analysis indicated that body mass index(OR=0.936,95％CI 0.891-0.984,P=0.010),eGFR(OR=0.985,95％CI 0.971-0.999,P=0.034),serum albumin level(OR=1.041,95％CI 1.011-1.072,P=0.007),24 hours urinary protein excretion(OR=1.092,95％CI 1.030-1.158,P=0.003),and platelet count(OR=0.996,95％CI 0.994-0.999,P=0.002)were independently associated with the severe bleeding following PRB in patients with advanced CKD.In the PRB cohort analyzed,the six most prevalent renal histological types were as follows:IgA nephropathy(46.3％,414/895),membranous nephropathy(11.1％,99/895),focal segmental glomerulosclerosis(8.5％,76/895),diabetic nephropathy(7.6％,68/895),sclerotic kidney disease(6.9％,62/895),and vascular sclerosis of the kidneys(4.9％,44/895).Conclusions Patients with advanced CKD exhibit a heightened risk of severe bleeding following PRB,estimated at approximately 22.9％.Independent risk factors for the occurrence of severe bleeding complications in these patients include low body mass index,reduced eGFR,decreased platelet count,elevated serum albumin,and increased urinary protein level.
万方数据