The effects of renal impairment on the pharmacokinetics of ceftriaxone in humans were examined after intravenous infusion of a 1-g dose over 15 min to 30 renally impaired patients. The study included 12 dialysis patients and 18 patients with severe, moderate, or mild renal impairment. Plasma and, where appropriate, urine and dialysate samples were collected at predetermined times and analyzed for ceftriaxone by highpressure liquid chromatography. The elimination half-life (group mean ranged from 11.7 to 17.3 h) and plasma clearance (group mean ranged from 529 to 705 ml/h) did not correlate linearly with creatinine clearance. The renal clearance and fraction of dose excreted unchanged in urine were related'linearly, however weakly, with creatinine clearance. Ceftriaxone was not, removed from plasma to a significant extent during hemodialysis. The half-life was prolonged twofold, the plasma clearance was lowered less than 50%, and the volume of distribution was relatively unchanged in renally impaired patients compared with young or elderly healthy subjects with normal renal function at an equivalent dose. Since these changes are moderate, adjustment in the dosage regimen of ceftriaxone for patients with impaired renal ftinction should not be necessary when ceftriaxone

Data are presented and renal function tests and Pcp measurements on consecutive blood and urine samples collected from 18 workers at a wood treatment plant before, during, and after a 20-day vacation. Pcp concentrations in blood averaging 5.1 ppm before vacation fell to 2.2 ppm during vacation but with a temporary rise early in this nonexposure period, suggesting a body tissues store of Pcp which was mobilized in response to a negative Pcp balance. Urine Pcp concentrations showed similar but less marked variations. Creatinine clearance and phosphorus reabsorption values were depressed before vacation but showed significant improvement during vacation, suggesting that Pcp exposure reduced both glomerular filtration rate and tubular function, with recovery following a nonexposure period.

A major drawback to kidney transplantation as a treatment for end stage renal disease is the common occurrence of rejection and failure of the transplanted kidney. We evaluated twenty-five dialysis patients, all of whom had suffered transplant failure during a ten year period. Of these, twenty-four had good psychological readjustment to chronic dialysis. Fourteen patients successfully grieved the loss of their kidneys. Ten denied any psychological difficulty in returning to dialysis and did not manifest the usual signs of grief. We suggest that the effectiveness of denial as a coping mechanism should be recognized and supported when present; in contrast, "grievers" should be helped through the grieving process and followed up to ensure resolution and proper readjustment to dialysis.

Denial has been documented as an important defense mechanism to helping the chronically ill cope with their disease. With respect to a dialysis population, however, the role of denial has been ambiguous. The purpose of this study were 1) to examine the physiological and psychological correlates of denial in a dialysis population and 2)( to examine the relationship between use of denial and compliance to fluid restrictions. Subjects were 46 self- and limited-care dialysis patients. From this subject pool two groups were derived, based upon weight gains between treatments: complies (N=15) and noncompliers(N=16). Both physiological and psychological data were correlated with denial as measured by the Marlow-Crowne Social Desirability Scale. Results indicated that denial is used a great deal in dialysis patients, but there was no difference in denial scores between compliers and noncompliers. For compliers, however, denial was correlated with more adaptive attitudes toward illness. The results have implication for the clinical management of dialysis patients.

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