The risk for major bleeding complications after percutaneous renal biopsy is higher among patients with than without diabetes, a new Japanese study finds.

In Japan, all percutaneous renal biopsies are performed in the hospital. In a nationwide inpatient database of 76,302 Japanese patients who underwent percutaneous renal biopsy, major bleeding complications occurred in 678 patients (0.9%), including 622 (0.8%) with red blood cell (RBC) transfusion within 7 days and 109 (0.1%) with invasive hemostasis requiring transcatheter arterial embolization or nephrectomy. Of the cohort, 8245 had diabetes mellitus.

Major bleeding complications (3.1% vs 0.6%), including requiring red blood cell transfusion (2.9% vs 0.66%), transfusion of more than 1 L (1.6% vs 0.1%), and invasive hemostasis (0.3% vs 0.1%) was significantly more common in the group with vs without diabetes. In multivariate analysis, the diabetes group had a 2.4-fold increased risk for major bleeding complications and a 2.4- and 1.9-fold increased risk for transfusion and invasive hemostasis, respectively, corresponding author Hideo Yasunaga, PhD, of The University of Tokyo in Japan, and colleagues reported in Kidney International Reports. Multiagent or insulin for diabetes treatment was significantly associated with a 1.6-fold increased risk for major bleeding complications, compared with single-agent treatment.

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The diabetes group tended to be older, male, and steroid users with acute kidney injury (AKI), chronic kidney disease (CKD), or rapidly progressing glomerulonephritis (RPGN). In multivariable analysis, older age, female sex, AKI, CKD, or RPGN, and steroid use each associated with higher risks of major bleeding. Diabetes mellitus remained a risk factor after adjustment for patient and hospital characteristics and in a sensitivity analysis considering anemia. The study was limited by a lack of information on needle gauge, glucose control, timing of discontinuation and resumption of antithrombotic agents, and some other relevant factors.

Recognizing the heterogeneity of kidney diseases among patients with diabetes, nephrologists are increasingly performing percutaneous renal biopsies.

Dr Yasunaga’s team concluded that “nephrologists should carefully judge whether the anticipated benefits outweigh the relatively high risk of major bleeding complications when considering [percutaneous renal biopsy] for patients with diabetes.”

In an accompanying editorial, Emilio D. Poggio, MD, of Glickman Urological and Kidney Institute at Cleveland Clinic in Cleveland, Ohio, and colleagues wrote that they “strongly support the practice of [percutaneous renal biopsy] in patients with diabetes when a secondary diagnosis is suspected, and identification of that disease would alter management with the hopes of reducing the progression to end-stage kidney disease. As in all patients with or without diabetic kidney disease, we recommend aggressively managing modifiable risk factors to reduce the risk of bleeding.”

Disclosure: One study author and several editorialists declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original references for a full list of authors’ disclosures.


Hasegawa S, Okada A, Aso S, et al. Association between diabetes and major bleeding complications of renal biopsy. Kidney Int Rep. eCollection 2022 Feb. doi:10.1016/j.ekir.2021.11.013

Taliercio JJ, McGuire M, Poggio ED, et al. Biopsying diabetics … How risky is it? Kidney Int Rep. eCollection 2022 Feb. doi:10.1016/j.ekir.2021.12.026