Propranolol disposition in renal failure.

1 Previous studies of propranolol disposition in renal failure have been conflicting. 2 Using simultaneous administration of [3H]-propranolol intravenously and unlabelled propranolol orally the principal determinants of drug distribution were calculated in normals, patients with severe renal impairment (creatinine clearance 14.5 +/- 2.8 ml/min) but not on haemodialysis and patients on haemodialysis (creatinine clearance less than 5 ml/min). 3 The effect of haemodialysis on propranolol binding and free fraction was also examined. The percentage of propranolol unbound rose from 7.1% to 9.9%. (P less than 0.001) 20 min following heparinization and beginning haemodialysis. This was accompanied by a large rise in free fatty acids from 0.567 +/- 0.059 to 3.326 +/- 0.691 mumol/ml (P less than 0.005). 4 The blood to plasma concentration ratios of propranolol were significantly higher in patients with renal failure (P less than 0.02) and on haemodialysis (P less than 0.001) and were significantly negatively correlated (P less than 0.001) with the haematocrit. 5 Although the half-life propranolol was significantly shortened in the patients with renal failure (P less than 0.02), there was no change in the apparent liver blood flow, extraction ratio or the principal determinants of steady-state drug concentrations in blood namely oral and intravenous clearance from blood. 6 There is, therefore, no pharmacokinetic basis to adjust the dosage of propranolol in patients with renal failure.

Home dialysis program of the Nashville VA Hospital.

Since 1965, 330 patients have received chronic dialysis treatment at the Nashville VA Hospital. Home hemodialysis training was established in 1968, and a unique class format has been used since 1970. Despite the national trend of fewer patients beginning home dialysis each year, more than 50 percent of our patients have chosen this form of therapy yearly since 1969. A total of 182 patients (55 percent) from 15 states have completed home training with an attrition rate of only 8 percent. Mean distance of patients' homes from the training center is 185 miles. Five-year survival for home hemodialysis patients is 91 percent, compared to 59 percent and 55 percent for patients receiving renal transplant and center dialysis, respectively. Seventeen deaths have occurred in home dialysis patients, half of which were due to cardiovascular disease. Home dialysis offers an excellent mode of therapy for patients with chronic renal failure and probably is particularly suitable for patients over 50 years of age.

Atypical herpesvirus hominis type 2 infection in uremic patients receiving immunosuppressive therapy.

In four uremic patients (three renal transplant recipients and one with idiopathic thrombocytopenia), painful, initially vesicular lesions developed in the anogenital region while they were receiving immunosuppressive drug therapy. These lesions enlarged, coalesced and ulcerated, presenting a puzzling diagnostic problem. Initial misdiagnoses often resulted in inappropriate antimicrobial therapy. Routine cultures, histologic sections and Tzanck preparations were seldom helpful. The correct diagnosis of herpesvirus hominis (HVH) infection was established within 18 to 48 hours by viral culture of swab or biopsy material. Subsequent identification of isolates as HVH type 2 was confirmed by neutralization kinetics, infectivity titers and ability to plaque in chick embryo cells. Various therapeutic regimens were ineffective. Clinical improvement best correlated with decrease in dosage of immunosuppressive agents.