I need some info.

[Jean]

Think I told most of you about my recent nuckear stress test, The Cardio doc said I should have that or an angiogram. Then I told her I was in 4th stage, so she said, no angio for you, we will do the stress test. Kudos for her, huh? The results of the stress test came back and NOW, I need an angiogram, since there is a 75% blockage in myleft ventricle. Now, my question is, I am at 24GFR, any one know how low this is going to take me?

[chiefsfan301]

I was at 25 gfr for about 5 years

[Nephrologista]

The left ventricle is the muscular chamber that pumps oxygenated blood returning from your lungs into the arterial system that feeds your body.  It operates at high pressure and is the "workhorse" of the heart.  Blockages occur in the coronary arteries, the blood vessels that supply the heart muscle with blood.  They don't occur inside the ventricle itself.  I suspect your blockage is of an artery that supplies the left ventricle, and this is a serious thing.

The dye used for the angiogram is kidney damaging.  There are some things you can do to protect yourself.  You should be well-hydrated before the test, with IV fluids.  If you have congestive heart failure these need to be run in slowly over a number of hours, but if your heart function is normal, they can go in quite fast.  NAC (N-acetylcysteine) is an inexpensive medication that may or may not help protect against contrast-induced kidney damage.  The only downside is that it tastes like rotten eggs, so mix it in some Diet Coke.  They should prescribe that for you.  Also, the cardiologist should limit the amount of dye they use.  They should not do a ventriculogram, since that looks at the ventricle function, can be done on an echo, and uses a whole lot of dye.  Finally, talk to your nephrologist about stopping your ace inhibitor or ARB for a day or two, if you're on one.

With good preparation and a small amount of dye exposure, you may be able to get through this with no further loss of kidney function.  It's good to be doing it now, so you have time to prepare, rather than in an emergency.

[Jean]

Thank you so much, that was very enlighteneing. I feel confident with my Cadio Dr., But am really disappointed that she did not call me with the results, it was my primary who called me and told me. Is a 75% blockage really bad?

[Nephrologista]

The thing is, a stress test doesn't give you a very precise measurement of the blockage.  The angiogram is probably better at that.  75% is, I *think*, just on the borderline of whether or not to place a stent.  So they might be hedging their bets, in case they get in there and the angiogram only shows a 60% blockage.

I'm not a cardiologist so I don't have all the numbers at my fingertips.  But yes, I would think an angiogram is a reasonable step at this point, especially if you're having symptoms like chest pain.  Heart disease is a leading killer of patients with chronic kidney disease.

[RightSide]

Another way to protect yourself from the damaging effects of the contrast dye, is to have a dialysis treatment immediately after the angiogram.  Today's dialyzers should be able to dialyze out most of that dye.

[Nephrologista]

Another way to protect yourself from the damaging effects of the contrast dye, is to have a dialysis treatment immediately after the angiogram.  Today's dialyzers should be able to dialyze out most of that dye.

The evidence for that approach is pretty slim.  I certainly wouldn't place a temporary access in order to do dialysis after contrast for an angiogram, and I probably wouldn't stick a fistula for the first time to do it either.   The problem is that the dye is toxic almost right away - by the time you're on the machine, some of the damage is done.  Best to be well hydrated and use a minimum of dye.

The only time I consider "dialyzing off the contrast" is for gadolinium, which is used only for MRI.  In the case of a PD patient who has to get gadolinium, the current recommendation is to place a temporary hemo access and do two treatments in 24 hours, with the first as soon as possible after the contrast.  That would probably hold true for a late stage four patient also.  PD is incredibly slow at removing gadolinium.  In reality, I have always bullied the non-kidney doctors into getting a different test instead.

[MooseMom]

Jean, what happens next?  Are you definitely going to have this done, or are you still thinking about it?  You're in a very difficult position, aren't you.

[Jean]

Oh of course, MM, I am going to have it done. My primary tells me the same info nephologista did, that if I am well hydrated with IV's and they use as little dye as possible, it might be okay., if not, then it's not. Cant go around with this much blockage anyways, I gotta tell you its kind of scary, and I am getting more and more short of breath and actually kind of scared to do anything. So, yes, it will be done. The sooner the better.

[MooseMom]

Oh man, Jean, I would be scared, too.  Scared to do something and scared to do nothing.  But I think that realistically speaking, the decision has already been made for you.  I'm sure you and your docs will do everything to protect your kidney function.  It's a classic catch-22 situation, and I don't envy you one bit.  When will the procedure be done?  Do you know yet?

[texasstyle]

I agree about being dialized right after.

[Jean]

the appt with my Cardio lady is the 21st. For all I know, she has already set it up, but then, I dont know. Hopefully it will not be too long. One Dr. says its an outpatient procedure and 2 friends have told me that when they put stents in you have to stay in a couple of days. Geez, make up my mind already!!!!