*Purpose: Desmopressin (DDAVP) is used for hemostasis in patients with factor VIII deficiency, von Willebrand disease and platelet function defects including that seen in patients with chronic kidney disease. A serious consequence of its use is water intoxication with attendant hyponatremia. We studied the incidence of hyponatremia in patients who received desmopressin during kidney transplant (KT) surgery.

*Methods: We retrospectively analyzed the incidence of hyponatremia (Na < 135) and severe hyponatremia (Na < 130) in the first 48 hrs following DDAVP used during KT surgery at our center between 2009-2018. We compared the incidence of hyponatremia in the first 48 after surgery with a control group of living and deceased KT recipients who did not receive DDAVP but were administered the same post-operative fluid protocol that the study group received. Relative risk (RR) and Fishers exact t test p values were used to determine the significance of differences between the two groups.

*Results: 22 patients met the inclusion criteria. 17 (77.3%) patients developed hyponatremia, and 8 (36.4%) developed severe hyponatremia (Mean 125.3, SD 3.93) (Table 1). In 25 controls (living donor 4; deceased donor 21) hyponatremia was noted in 17 (68%), but no patient developed severe hyponatremia. There was no significant difference between the groups for the incidence of hyponatremia (RR 1.13 [0.7-1.62], p=0.35). However, severe hyponatremia was noted only in patients who received DDAVP; 3 out of 4 living KT recipients (75%) and 4/18 (22.2%) deceased donor recipients (p = 0.0027).

*Conclusions: In this retrospective analysis of the incidence of hyponatremia, among KT recipients who were given DDAVP for intraoperative hemostasis, there was a significantly higher incidence of severe hyponatremia (75% of living KT recipients, and 22.2% of deceased recipients) compared to patients who did not receive DDAVP. Although larger retrospective analyses are required to further validate these findings, the risk of severe hyponatremia should be acknowledged and anticipated if patients are administered DDAVP during KT surgery.

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