What is the recommended dose of Ddavp (Desmopressin) for a bleeding End-Stage Renal Disease (ESRD) patient?

Desmopressin (DDAVP) Dosing for Bleeding ESRD Patients

For bleeding ESRD patients, the recommended dose of DDAVP (desmopressin) is 0.3 μg/kg intravenously, diluted in 50 ml saline and infused over 30 minutes. 1

Mechanism of Action and Indications

• DDAVP enhances platelet adherence and platelet aggregate growth on human artery subendothelium, making it particularly useful for patients with impaired platelet function 1
• DDAVP is especially indicated for ESRD patients who have uremic platelet dysfunction, which contributes significantly to their bleeding risk 2
• In uremic patients, DDAVP has been shown to shorten bleeding time and increase platelet retention, improving hemostasis 3

Dosing Protocol

• The standard intravenous dose is 0.3 μg/kg diluted in 50 ml saline and infused over 30 minutes 1
• For subcutaneous administration, the dose is also 0.3 μg/kg 4
• DDAVP can be administered as a single dose prior to invasive procedures in uremic patients to reduce bleeding risk 2

Clinical Efficacy in ESRD

• Studies have demonstrated that DDAVP significantly shortens collagen/epinephrine-closure time from 252.7 ± 40.7 to 144.6 ± 51.0 seconds in uremic patients on antiplatelet therapy 2
• DDAVP infusion leads to increased plasma levels of factor VIII coagulant (FVIII:C) and von Willebrand factor (vWF) activities in uremic patients 3
• A single infusion before invasive procedures in uremic patients taking antiplatelet drugs has been shown to improve platelet dysfunction and reduce bleeding complications 2

Important Monitoring and Precautions

• Monitor for potential adverse effects including water retention with consecutive hyponatremia and convulsions, particularly in elderly patients 1
• After DDAVP administration, slight decreases in hematocrit and platelet count may occur without significant changes in prothrombin time or activated partial thrombin time 2
• Fluid restriction should be observed to prevent water intoxication 5
• Polydipsia is a contraindication to desmopressin treatment 5

Alternative Approaches

• For patients with severe bleeding who don't respond adequately to DDAVP, consider:
  • Combined approach of platelet concentrates followed by desmopressin administration to enhance recovery of normal platelet function 1
  • Local measures to control bleeding and appropriate reversal agents if the patient is on anticoagulants 1

Clinical Decision Algorithm

1. Confirm ESRD patient has active bleeding or requires an invasive procedure
2. Assess for contraindications (polydipsia, severe hyponatremia)
3. Calculate dose: 0.3 μg/kg IV diluted in 50 ml saline
4. Administer over 30 minutes
5. Monitor for clinical response and adverse effects
6. Consider additional hemostatic measures if bleeding persists