title: Manifestation of tranexamic acid toxicity in chronic kidney disease and kidney transplant patients: A report of four cases and review of literature.
abstract: OBJECTIVE
  Tranexamic acid (TXA) is a synthetic anti-fibrinolytic agent commonly used for the prevention and treatment of bleeding disorders. The aim of this study is to describe the clinical manifestation of TXA toxicity in chronic kidney disease (CKD) patients.
  
  
  METHODS
  From 2005 to 2014, we encountered four CKD patients who experienced severe complications related to TXA. Clinical manifestations and outcome of these patients were recorded. We then performed a qualitative literature review of published cases of TXA toxicity in CKD patients in the PubMed database from 1 January 1972 to 31 December 2015.
  
  
  RESULTS
  In our centre, two peritoneal dialysis (PD) patients developed neurotoxicity after intravenous TXA use for surgical bleeding and one PD patient developed neurotoxicity after oral TXA use for post-polypectomy colonic bleeding. One kidney transplant recipient developed acute obstructive uropathy due to retention of blood clot at the pelvi-ureteric junction of graft kidney after taking oral TXA for menorrhagia. Dosage of TXA was not adjusted according to renal function in all cases. All of them recovered without permanent disability after TXA was stopped. From our literature search, we identified two cases of neurotoxicity (one PD, one stage 4 CKD patient), one case of retinal toxicity in a haemolysis (HD) patient, one case of ligneous conjunctivitis in a CKD patient, and one case of toxic epidermal necrolysis in a CKD patient.
  
  
  CONCLUSIONS
  Neurotoxicity is a very common clinical manifestation of TXA toxicity in CKD patients. Thrombotic complication is rare. Dosage adjustment of TXA is essential in CKD patients.
authors.affiliation: Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Terry King-Wing
authors.initials: TK
authors.lastname: Ma
authors.affiliation: Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Kai Ming
authors.initials: KM
authors.lastname: Chow
authors.affiliation: Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Bonnie Ching-Ha
authors.initials: BC
authors.lastname: Kwan
authors.affiliation: Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Chi Bon
authors.initials: CB
authors.lastname: Leung
authors.affiliation: Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Cheuk Chun
authors.initials: CC
authors.lastname: Szeto
authors.affiliation: Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Philip Kam-Tao
authors.initials: PK
authors.lastname: Li
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008595:Menorrhagia / Q000517:prevention & control*; D008875:Middle Aged; D020258:Neurotoxicity Syndromes / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D010531:Peritoneal Dialysis, Continuous Ambulatory; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D013927:Thrombosis / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D013997:Time Factors; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000009:adverse effects*; D016896:Treatment Outcome; D014517:Ureteral Obstruction / Q000209:etiology
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: chronic kidney disease; toxicology; tranexamic acid