From the FDA Drug Label
The blood levels of tranexamic acid are increased in patients with renal insufficiency. Urinary excretion following a single intravenous injection of tranexamic acid declines as renal function decreases Therefore, dose adjustment is needed in patients with renal impairment [see DOSAGE AND ADMINISTRATION (2.2), USE IN SPECIFIC POPULATIONS (8. 6)]. Reduce the dosage of tranexamic acid in patients with renal impairment, based on the patient’s serum creatinine [see DOSAGE AND ADMINISTRATION (2.2), CLINICAL PHARMACOLOGY (12.3)].
Tranexamic acid can be administered to a patient with Chronic Kidney Disease (CKD) stage 5, undergoing Hemodialysis (HD), but the dosage needs to be reduced based on the patient’s serum creatinine 1 1.
- Dose adjustment is necessary in patients with renal impairment.
- The patient’s renal function should be taken into consideration when administering tranexamic acid.
From the Research
Tranexamic acid can be administered to a patient with Chronic Kidney Disease (CKD) stage 5, undergoing Hemodialysis (HD), but with careful dose adjustment and monitoring. The most recent and highest quality study on this topic is from 2018 2, which provides guidance on dosing regimens for patients with chronic renal dysfunction, including those on hemodialysis.
Key Considerations
- Tranexamic acid is primarily eliminated by the kidneys, with approximately 90% of the drug excreted unchanged in urine, necessitating dose adjustment in patients with severe renal impairment.
- Hemodialysis removes tranexamic acid, with approximately 30% cleared during a standard session, supporting post-dialysis dosing.
- Patients with CKD stage 5 on hemodialysis require a recommended dose of typically 10-15 mg/kg IV or 10-25 mg/kg orally, administered after each dialysis session.
- The standard dosing interval should be extended to every 24 hours for oral administration in these patients.
- Monitoring for signs of bleeding, thrombotic events, and neurological symptoms such as seizures is crucial due to the risk of accumulation and toxicity.
Clinical Application
The use of tranexamic acid in patients with CKD stage 5 on hemodialysis should be approached with caution, considering the potential for accumulation and toxicity. However, with appropriate dose adjustment and monitoring, it can be a valuable tool in managing bleeding complications. As noted in a study from 2017 3, dosage adjustment of tranexamic acid is essential in CKD patients to avoid toxicity, and the drug can be used safely when properly managed.
Safety and Efficacy
Studies have shown that tranexamic acid can be effective in treating severe hematuria in patients with polycystic kidney disease, including those with chronic kidney disease class IV 4. However, the potential for thrombotic complications and the need for careful patient selection and monitoring must be considered. A study from 2012 5 highlighted the importance of dose adjustment for renal impairment and the potential benefits of tranexamic acid in preserving renal function by stopping hematuria episodes.