From the FDA Drug Label
For patients with moderate to severe impaired renal function, the following dosages are recommended: Table 1. Recommended Dosage in Patients with Varying Degrees of Renal Impairment Serum Creatinine (mg/dL) Tranexamic acid IntravenousDosage 1.36 to 2.83 (120 to 250 micromol/L) 10 mg/kg twice daily 2.83 to 5. 66 (250 to 500 micromol/L) 10 mg/kg daily
5. 66 (>500 micromol/L) 10 mg/kg every 48 hours or 5 mg/kg every 24 hours
- Dose reduction is recommended for all doses, both before and after tooth extraction.
Tranexamic acid can be administered to patients with Chronic Kidney Disease (CKD) stage 5, also known as End-Stage Renal Disease (ESRD), but the dosage should be reduced. For patients with serum creatinine >5.66 mg/dL, the recommended dosage is 10 mg/kg every 48 hours or 5 mg/kg every 24 hours 1.
From the Research
Tranexamic acid can be administered to patients with Chronic Kidney Disease (CKD) stage 5, also known as End-Stage Renal Disease (ESRD), but with necessary dose adjustments to minimize the risk of toxicity and adverse effects. The most recent and highest quality study, 2, suggests that tranexamic acid dosing regimens should be decreased in patients with chronic kidney dysfunction secondary to reduced clearance and drug accumulation.
Key Considerations
- Dose adjustment is crucial in patients with CKD stage 5 to prevent drug accumulation and toxicity, as tranexamic acid is primarily eliminated by the kidneys 3, 4, 2.
- The recommended dose for patients with severe renal impairment (CKD stage 5) is typically 10 mg/kg intravenously or 25% of the normal oral dose, which is usually 500-650 mg orally twice daily instead of the standard 1000-1300 mg three times daily 3, 2.
- Administration of tranexamic acid after hemodialysis in dialysis-dependent patients is advisable, and close monitoring for adverse effects, particularly thrombotic complications, is essential 4, 2.
- Consultation with a nephrologist before administration is recommended to ensure appropriate dosing based on the patient's specific renal function 3, 2.
Clinical Evidence
- Studies have shown that tranexamic acid can be effective in managing bleeding in CKD stage 5 patients, including those with autosomal dominant polycystic kidney disease (ADPKD) and severe hematuria 5, 6.
- However, the use of tranexamic acid in CKD patients requires careful consideration of the potential risks and benefits, as well as close monitoring for adverse effects 4, 2.