Perioperative vitamin C supplementation may not reduce bleeding in percutaneous renal biopsy patients

1. Administration of perioperative intravenous vitamin C for percutaneous renal biopsy may not reduce the rate of bleeding complications.  

Evidence Rating Level: 1 (Excellent)

PRB is an essential procedure for diagnosing many kidney diseases. As an invasive procedure, it carries inherent side effects of bleeding and pain. Although PRB is minimally invasive, severe hematomas can cause significant pain or even require transfusion or angioembolization. Thus, there is a need for pharmacological strategies to reduce the incidence of these side effects. Vitamin C has been shown to promote homeostasis and alleviate pain and was associated with decreased bleeding events in gynecological and endoscopic surgeries. This single-center, prospective, open-label, randomized controlled trial included adults with chronic kidney disease scheduled for percutaneous ultrasound-guided kidney biopsy. 710 patients were randomized to receive either intravenous vitamin C (20 mg/kg, diluted in 100 mL of 0.9% sodium chloride) administered at 6 hours before and 18 hours after the biopsy (n = 355; mean [SD] age, 46.15 [14.67] years; 41.1% female), or standard care (n = 355; mean [SD] age, 49.25 [14.25] years; 40.8% female). The primary outcome was the area of perirenal hematoma on renal ultrasound at 24 hours and self-reported pain intensity (Visual Analogue Scale, VAS). There were no significant differences in perirenal hematoma area (adjusted mean difference: 4.44 mm² (95% CI, -52.31 to 61.18 mm2; P = 0.878) or incidence of perirenal hematoma (56.3% in the vitamin C arm versus 50.1% in the control arm (risk ratio, 1.12; 95% CI, 0.98-1.29; P = 0.098). There were no significant differences in median VAS score at 2 hours, 12 hours, or 24 hours post-biopsy (adjusted P = 0.105, 0.192, and 0.534, respectively). Vitamin C was well-tolerated, and rates of adverse events were low and comparable between groups.

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