We report the pharmacokinetic parameters of ceftriaxone in 11 patients on hemodialysis with end-stage renal disease (ESRD; creatinine clearance < 5 ml/ min/1.73 m²). The patients were studied during the interdialysis period and during 4h of hemodialysis. The mean age was 53.4 years. After the administration of 1 g of ceftriazone during a constant intravenous infusion over a 30-min period, t_½ was 16.6 h, β was 0.0418 ± 0.0106 h^-1, V_D was 14.5 ± 3.0 liters/1.73 m² and Cl_p was 0.40 ± 0.05 liters/h for the interdialysis period. Hemodialysis started 24 h after the infusion. The initial plasma ceftriaxone concentration was 68.6 ± 10.8 μg/ml. This value dropped to 40.4 ± 4.7 μg/ml at the end of the 4th hour, indicating a significant 41% decay in blood levels during hemodialysis (p < 0.001). The t_½ decreased to 4.88 h, k_el rose to 0.142 ± 0.0250 h^-1 and Cl_p increased to 1.73 ± 0.44 liters/h. All values were highly significantly different (p < 0.001) from those during the interdialysis period. The plasma ceftriaxone concentration of 40.4 ± 4.7 μg/ml at the end of hemodialysis was well within the therapeutic range of the drug. We conclude that ceftriaxone has a moderated increase in t_½ in patients with ESRD. Ceftriaxone is significantly dialyz-able, however, the plasma concentrations are in the therapeutic range by the end of a 4-hour hemodialysis, 28 h after the administration of the drug. We propose that 1 g given intravenously before each hemodialysis will be sufficient to keep the patient’s plasma concentrations within the therapeutic range until the next hemodialysis. If the interdialysis period is longer than 48 h an extra dose should be administered.

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Background: The percutaneous treatment of coronary artery disease has been revolutionized by the use of drug-eluting stents (DES). However, its use in the daily practice involves patients with more complex clinical and angiographic characteristics than those found in randomized trials. This registry was designed to characterize diabetic patients and their outcomes following DES implantation in our country. Methods: Prospective single-center registry enrolling consecutive patients after DES implantation. Clinical, angiographic and procedurerelated data, as well as early and long-term outcomes were recorded. The primary endpoint, including cardiac death, myocardial infarction or target lesion revascularization, was compared between diabetics and non-diabetics. Results: We evaluated 1,670 patients treated with DES from 2002 to 2012 with a follow-up of 3.2 ± 2.5 years. One third of the patients were diabetic and had lower event-free survival when compared to non-diabetic patients (79.4% vs. 82.6%; P = 0.015). The adjusted odds ratio, however, was 1.22 (95% CI, 0.89-1.69) and was not significant. A significantly lower event-free survival was observed in the subgroup of patients receiving insulin, whereas it was similar for diabetic and nondiabetic patients in the subgroup not receiving insulin (68.7% vs. 83.9% vs. 82.8%, respectively; P < 0.01). The adjusted odds ratio was 1.72 (95% CI, 1.13-2.63) higher for diabetic patients receiving insulin when compared to the remaining patients.

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