Tranexamic acid increases peritoneal ultrafiltration volume in patients on CAPD

Area of Science:

• Nephrology
• Renal Replacement Therapy
• Peritoneal Dialysis

Background:

• Maintaining ultrafiltration (UF) capacity is critical for long-term continuous ambulatory peritoneal dialysis (CAPD).
• Ultrafiltration loss is a common complication in CAPD patients.
• Bradykinin (BK) and tissue plasminogen activator (tPA) systems may play a role in peritoneal membrane function.

Purpose of the Study:

• To investigate the effect of the antiplasmin agent tranexamic acid (TNA) on UF volume in CAPD patients.
• To determine if TNA influences peritoneal permeability, clearance, and BK/tPA concentrations.

Main Methods:

• A study involving 15 CAPD patients (5 with UF loss, 10 without).
• Evaluation of TNA's effect on UF volume, peritoneal permeability, peritoneal clearance, and BK/tPA concentrations.
• Oral TNA administration for 2 weeks, with additional intraperitoneal administration in one patient.

Main Results:

• TNA significantly increased UF volume in all patients with UF loss and in 70% of patients without UF loss.
• TNA enhanced peritoneal clearances of urea and creatinine but did not affect peritoneal equilibration test (PET) parameters or glucose reabsorption.
• Significant decreases in blood and drainage BK and tPA concentrations were observed in patients with UF loss following TNA treatment.

Conclusions:

• TNA enhances UF volume in CAPD patients, irrespective of UF loss.
• The mechanism of TNA's UF-enhancing effect is not fully elucidated but may involve suppression of the BK and/or tPA system, particularly in patients with UF loss.
• TNA appears to be a potential therapeutic agent for improving UF capacity in CAPD.