Creation of a Pre-biopsy Clinical Risk Score for Major Bleeding After Kidney Biopsy
4 affiliations
- 1Department of Nephrology, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo, Japan
- 2Department of Nephrology, Musashino Red Cross Hospital, Musashino, Tokyo, Japan
- 3M&D Data Science Centre, Institute of Integrated Research, Institute of Science Tokyo, Tokyo, Japan
- 4Department of Population Health Sciences, University of Bristol, Bristol, Bristol, UK
Abstract
Introduction: Risk-based tools to guide care after percutaneous kidney biopsy (PKB) remain limited. We developed a simple preadmission risk score to predict post-PKB bleeding and support same-day discharge decisions, leveraging Japan’s routine inpatient observation practice.
Methods: This retrospective study included 78,817 adults undergoing native PKB, using a nationwide Japanese inpatient database (2016–2021). Risk factors for early hemostatic intervention, defined as blood transfusion or surgical or interventional hemostasis within 6 days after PKB, were evaluated using logistic and L2-penalized multinomial logistic regressions. The fitted coefficients for day 0 were discretized to develop the Kidney biopsy Bleeding Index for Triage (K-BIT), using readily obtainable prebiopsy clinical variables. The scoring was internally validated using a held-out test cohort from the same dataset.
Results: The overall bleeding rate was 1.46%. Compared with chronic glomerulonephritis, bleeding risk was higher in acute kidney injury (odds ratio [OR], 10.9; 95% confidence interval [CI], 8.55–13.9) and rapidly progressive glomerulonephritis (OR, 6.67; 95% CI 5.48–8.12). Increasing age and lower body mass index (BMI) were independently associated with higher bleeding risk. Age, prebiopsy diagnostic risk tier, BMI, and Charlson Comorbidity Index (CCI) were selected for score construction (score range, 0–9). In the validation cohort, patients with scores ≤ 2 (55.4%) had a bleeding risk of 0.37%. Simulation analysis suggested that restricting early discharge to this low-risk group could reduce hospitalization by an estimated 332 hospital days per 100 patients while maintaining low postdischarge bleeding risk.
Conclusion: Prebiopsy diagnosis, age, BMI, and comorbidities were key predictors of postbiopsy bleeding. K-BIT may support risk stratification and outpatient kidney biopsy pathways.
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BibTeX
@article{suzukawa2026creation,
title = {{Creation of a Pre-biopsy Clinical Risk Score for Major Bleeding After Kidney Biopsy}},
author = {Rena Suzukawa and Daiei Takahashi and Takanori Hasegawa and Shunsuke Inaba and Ken Ikenouchi and Yuta Nakano and Yurina Yataka and Mizuki Watada and Motoki Hoshino and Wakana Shoda and Tamaki Kuyama and Eisei Sohara and Kiyohide Fushimi and Shinichi Uchida and Shintaro Mandai},
journal = {Kidney International Reports},
year = {2026},
month = oct,
doi = {10.1016/j.ekir.2026.107118},
url = {https://doi.org/10.1016/j.ekir.2026.107118},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Creation of a Pre-biopsy Clinical Risk Score for Major Bleeding After Kidney Biopsy
AU - Rena Suzukawa
AU - Daiei Takahashi
AU - Takanori Hasegawa
AU - Shunsuke Inaba
AU - Ken Ikenouchi
AU - Yuta Nakano
AU - Yurina Yataka
AU - Mizuki Watada
AU - Motoki Hoshino
AU - Wakana Shoda
AU - Tamaki Kuyama
AU - Eisei Sohara
AU - Kiyohide Fushimi
AU - Shinichi Uchida
AU - Shintaro Mandai
PY - 2026
DA - 2026/10/01
JO - Kidney International Reports
DO - 10.1016/j.ekir.2026.107118
UR - https://doi.org/10.1016/j.ekir.2026.107118
AB - Introduction: Risk-based tools to guide care after percutaneous kidney biopsy (PKB) remain limited. We developed a simple preadmission risk score to predict post-PKB bleeding and support same-day discharge decisions, leveraging Japan’s routine inpatient observation practice. Methods: This retrospective study included 78,817 adults undergoing native PKB, using a nationwide Japanese inpatient database (2016–2021). Risk factors for early hemostatic intervention, defined as blood transfusion or surgical or interventional hemostasis within 6 days after PKB, were evaluated using logistic and L2-penalized multinomial logistic regressions. The fitted coefficients for day 0 were discretized to develop the Kidney biopsy Bleeding Index for Triage (K-BIT), using readily obtainable prebiopsy clinical variables. The scoring was internally validated using a held-out test cohort from the same dataset. Results: The overall bleeding rate was 1.46%. Compared with chronic glomerulonephritis, bleeding risk was higher in acute kidney injury (odds ratio [OR], 10.9; 95% confidence interval [CI], 8.55–13.9) and rapidly progressive glomerulonephritis (OR, 6.67; 95% CI 5.48–8.12). Increasing age and lower body mass index (BMI) were independently associated with higher bleeding risk. Age, prebiopsy diagnostic risk tier, BMI, and Charlson Comorbidity Index (CCI) were selected for score construction (score range, 0–9). In the validation cohort, patients with scores ≤ 2 (55.4%) had a bleeding risk of 0.37%. Simulation analysis suggested that restricting early discharge to this low-risk group could reduce hospitalization by an estimated 332 hospital days per 100 patients while maintaining low postdischarge bleeding risk. Conclusion: Prebiopsy diagnosis, age, BMI, and comorbidities were key predictors of postbiopsy bleeding. K-BIT may support risk stratification and outpatient kidney biopsy pathways.
SN - 2468-0249
ER -