Kuriyama S, Nakayama M, Tomonari H, Kawaguchi Y, Hosoya T
Division of Nephrology, Saiseikai Central Hospital, Tokyo, Japan.
Perit Dial Int. 1999 Jan-Feb;19(1):38-44.
The preservation of ultrafiltration (UF) capacity is crucial to maintaining long-term continuous ambulatory peritoneal dialysis (CAPD).The aim of the present study was to investigate whether the antiplasmin agent tranexamic acid (TNA) increases UF volume in CAPD patients.
Fifteen patients on CAPD, 5 with UF loss and 10 without UF loss, were recruited for the study. The effect of TNA was evaluated with respect to changes in UF volume, peritoneal permeability, peritoneal clearance, bradykinin (BK), and tissue plasminogen activator (tPA) concentration.
Dialysis unit of the Saiseikai Central Hospital.
In patients with UF loss, 2 weeks of treatment with oral TNA produced a significant increase in UF volume in all subjects (5/5).TNA also produced a significant increase in peritoneal clearances of urea and creatinine (Cr). However, the peritoneal equilibration test (PET) revealed that TNA had no effect on dialysate/plasma (D/P) Cr, Kt/V, or the protein catabolic rate (PCR).TNA also had no effect on net glucose reabsorption. In contrast, significant decreases in BK and blood tPA concentrations in response to TNA treatment were noted. BK concentration in drainage fluid was also reduced. In the case of patients without UF loss,TNA produced an increase in UF volume in 70% (7/10). However, no differences were found in blood and drainage BK and tPA concentrations between theTNA treatment and nontreatment periods in these patients. A comparison of basal BK and tPA concentration showed that there were no differences in these parameters between patients with UF loss and those without loss of UF. Furthermore,TNA given intraperitoneally to a patient also produced a marked increase in UF volume.
The present study suggests thatTNA enhances UF volume in patients both with and without UF loss. SinceTNA did not affect peritoneal permeability and glucose reabsorption, the mechanism by which TNA exerts an enhancing action on UF is largely unknown. We speculate that it may be associated with suppression of the BK and/or tPA system, at least in patients with UF loss.
维持超滤（UF）能力对于长期持续非卧床腹膜透析（CAPD）至关重要。本研究旨在探讨抗纤溶药物氨甲环酸（TNA）是否能增加CAPD患者的超滤量。
招募了15例CAPD患者，其中5例存在超滤功能丧失，10例无超滤功能丧失，进行该研究。从超滤量、腹膜通透性、腹膜清除率、缓激肽（BK）和组织型纤溶酶原激活剂（tPA）浓度的变化方面评估TNA的效果。
西淀川中央医院透析科。
在超滤功能丧失的患者中，口服TNA治疗2周后，所有受试者（5/5）的超滤量均显著增加。TNA还使尿素和肌酐（Cr）的腹膜清除率显著增加。然而，腹膜平衡试验（PET）显示，TNA对透析液/血浆（D/P）Cr、Kt/V或蛋白质分解代谢率（PCR）无影响。TNA对葡萄糖净重吸收也无影响。相反，观察到TNA治疗后BK和血液tPA浓度显著降低。引流液中的BK浓度也降低。在无超滤功能丧失的患者中，TNA使70%（7/10）的患者超滤量增加。然而，这些患者在TNA治疗期和非治疗期之间，血液和引流液中的BK和tPA浓度没有差异。基础BK和tPA浓度的比较显示，超滤功能丧失的患者和无超滤功能丧失的患者在这些参数上没有差异。此外，对一名患者进行腹腔内给予TNA也使超滤量显著增加。
本研究表明，TNA可增加有或无超滤功能丧失患者的超滤量。由于TNA不影响腹膜通透性和葡萄糖重吸收，TNA对超滤发挥增强作用的机制很大程度上尚不清楚。我们推测，至少在超滤功能丧失的患者中，这可能与BK和/或tPA系统的抑制有关。
