Efficacy of desmopressin in reducing post-procedural bleeding among chronic kidney disease patients: a systematic review and meta-analysis.

INTRODUCTION: Chronic kidney disease (CKD) is associated with uremic-related platelet dysfunction and a greater risk of perioperative bleeding. Desmopressin (DDAVP) is believed to improve platelet function and is used prophylactically to prevent post-operative bleeding, but with uncertain efficacy. In this research, we evaluated the efficacy of peri-procedural desmopressin administration in reducing bleeding complications in CKD patients. METHODS: We searched PubMed, Scopus, and Embase up to August 2025 for randomized controlled trials (RCTs) and observational studies involving adult CKD patients undergoing non-surgical procedures who received peri-procedural desmopressin compared to a control group. Outcomes included overall bleeding events, hematoma, hematuria, hematocrit decline, transfusions, and interventions for bleeding control. Safety profile of hyponatremia was also assessed. RESULTS: Of 1,744 records, a total of 7,944 participants from 21 studies were included. The meta-analysis showed that desmopressin did not significantly reduce overall bleeding events (OR 0.87, 95% CI 0.57-1.33). Similarly, there was no significant effect on the incidence of hematoma (OR 1.35, 95% CI 0.40-4.53) or hematuria (OR 1.44, 95% CI 0.50-4.12). Subgroup analysis restricted to randomized controlled trials (RCTs) demonstrated a significant reduction in overall bleeding events with desmopressin (OR 0.50, 95% CI 0.29-0.87). Further subgroup analysis by route of administration revealed that the intranasal route was associated with a significant reduction in total bleeding events (OR 0.52, 95% CI 0.32-0.84). CONCLUSION: This study suggests that desmopressin does not significantly reduce post-procedural bleeding in CKD patients. However, subgroup analyses restricted to RCTs, and the intranasal administration route suggest a reduction in bleeding complications. SYSTEMATIC REVIEW REGISTRATION: PROSPERO ID: CRD420251118342, URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251118342.