Risk of Bleeding in Patients with Chronic Kidney Disease Undergoing Bronchoscopy

Abstract

Background: Complications rates from bronchoscopy are low, however chronic kidney disease (CKD) is considered a risk factor for procedural bleeding. The aim of the study is to evaluate bleeding complications CKD patients undergoing bronchoscopy with either transbronchial (TBLB), endobronchial biopsies (EBBX), Endobronchial Ultrasound transbronchial needle aspiration (EBUS-TBNA) and/or brushings. Methods: Retrospective analysis of patients with Chronic kidney disease who underwent bronchoscopy with biopsy, brushings and/or transbronchial needle aspiration from 2012 to 2019. Patients were grouped in 5 groups based on the National Kidney Foundation clinical guidelines. Bleeding was categorized as mild, moderate, and severe bleeding. Results: 894 patients were identified; bleeding complications were seen in 103 (11.5%) patients. Mild bleeding in 51 (5.7%), moderate bleeding in 46 (5.1%) and severe bleeding in 6 (0.67%) cases. No association between CKD subgroups and bleeding complications. There were no differences in number of biopsies or passes done in CKD groups. 790 (88%) patients underwent TBLB followed by brushing in 329 (36.8%), EBBX in 300 (33.5%) and EBUS-TBNA in 290 (32.4%). Majority of bleeding complications occurred in patients undergoing TBLB. Patients with serum creatinine of 2 mg/dL or higher vs 3 mg/dL had no statistical difference for bleeding complication. Conclusion: There is no correlation in bleeding complications in patients with CKD undergoing Bronchoscopic biopsies. Most of complications were mild or moderate and did not required major interventions; risk of severe bleeding remains low, in those patients.  There is no correlation between CKD stage or use of empirical serum creatinine cut off and risk of bleeding. Bronchoscopy remains a safe procedure in patients with CKD.