HELP - MRI with contrast for dialysis patients question

[WishIKnew]

So I went for my MRI this morning (we are doing an MRI because they have found breast cancer and want to be sure they have found it all before surgery) and was told to come back tomorrow so they can do the MRI just hours before my next scheduled dialysis treatment.  The dye (gadolinium or something like that) can cause a potentially fatal skin desease in patients with kidney failure.  I'm totally freaked out.  My nephrologist is out of town until Tuesday.  His backup nephrologist says there is a risk but if I was his sister he'd say do the MRI.  Oh, I hate knowing that they are guessing with my health.  I'm so freaked out.  Should I do the MRI.  Are there other options???   What would you do?

[billybags]

I am sure there is a weaker dye that they can give dialysis patients. When my husband had heart surgery they were most careful about the amount they gave him. I do not no what to tell you, it is worrying and that's the last thing you want.

[Willis]

I'm allergic to the contrast dye (I had a bad reaction once) and now it's something I always tell them they can't use. There is an alternative...I think it was CO2 and the radiologist said that it's a second choice, but still gives adequate results if used correctly. I think they charge more for the procedures though! He also said to always just tell the technicians that you have ESRD and supposedly the protocols then call for use of the CO2 method only.

 

[WishIKnew]

Thanks!

Is the CO2 safe?  No potentially fatal side effects?

[Willis]

Thanks!

Is the CO2 safe?  No potentially fatal side effects?

I don't know the full answer to that...I've been told it was safe. Personally, I didn't have any after effect that I could tell, but that doesn't necessarily mean the CO2 has no side effects.

Here...I found an interesting link for you...

CONCLUSIONS: CO2 arteriography provides accurate, clinically useful arterial imaging with minimal risk. Thus, this new technology significantly increases the utility of arteriography in patients with peripheral vascular disease.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1242879/

 

[sullidog]

Last time I had a fistulagram they were going to give me bicarb, they said it protects you from the dye, but they didn't end up giving it to me cause my kidneys are dead anyways. Apparently this bicarb has to have its own seperate IV.

[*kana*]

I recently was aggressively pressured into doing an MRI with that nasty contrast.  I kept refusing due to the FDA's black box warning and also seeing others at my old clinic with fibrosis.  They say that you might not get fibrosis right away and getting a transplant doesnt prevent you from getting it either.  I just wouldnt risk it if I were you.  It does a lot of damage and most people die after a few years after diagnosis.  Your skin gets tight, you end up in a wheelchair and then your lungs become effected by it....no thanks. 

Can't they do a CT with dye?       

[cookie2008]

I would have the MRI to see and make sure they find it all, then have my dialysis.  I know enough people with breast cancer, my sister-in-law just had her left breast removed due to it and the chemo is rough.

[Ang]

as far as i was AWARE contrast was not a big thing for dialysis patients, had a few procedures with the dye and never was a

word said.

but contrast  dye in tx patients is a no no,(can kill the kidney)but had a procedure during my dramas after tx with minor amount of contrast.
thank god no effects

[Stoday]

I had an MRI last year with contrast dye. I think they used an alternative to Gadolinium but it was still radioactive. I can't remember what it was. They arranged the scan so that I dialysed in the same hospital an hour or two after the scan.

[RichardMEL]

I've had two MRI's in the last month or so.

Both times they brought up using contrast dye. I reminded them I was a transplant patient and politely but firmly refused (which they understood and didn't take personally ). I did say that if they really felt it was required I wanted it to go through the transplant team, or at the very least the renal reg for their OK before it wasd done.

As it was both times they said the pics were all good without the dye (not hard when doing a brain scan and there's nothing there  ).

so yeah.. definitely a concern the dye.

Ang. I was also under the impression it was bad karma for those with kidney failure/reduced function as well as tx patients.

[okarol]

Baking Soda Prevents Kidney Damage From Intravenous Dye
Sodium bicarbonate safer than saline during test for heart disease
New York, NY
4/1/09
Your choice of which intravenous solution to use during tests with dye injected to visualize internal organs or the vascular system can make a difference as to whether or not you will sustain kidney damage. According to a report in the April issue of the American Journal of Kidney Diseases, the official journal of the National Kidney Foundation, a mixture of water and sodium bicarbonate – the ingredient in baking soda – is safer than a low-salt solution called saline.
Radiocontrast agents are a type of medical contrast medium (dye) used to improve the visibility of internal bodily structures in imaging techniques such as computed tomography (CT) or X-ray imaging. Modern contrast agents are typically based on iodine. Most often they are used intravenously.
Contrast-induced nephropathy may occur when the filtering units of the kidney are damaged, explained Dr. Bryan N. Becker, MD, president of the National Kidney Foundation. This damage allows protein normally kept in the blood plasma to leak into the urine in large amounts. Since the protein in the blood helps keep fluid in the bloodstream, this type of kidney injury can also be associated with swelling or edema.
If severe enough, contrast-induced nephropathy can cause kidney failure that requires kidney dialysis to help remove toxins from the blood, or a transplant.
To minimize the risk of contrast-induced nephropathy, various actions can be taken if the patient has predisposing conditions. Three factors have been associated with an increased risk of contrast-induced nephropathy: preexisting renal insufficiency, diabetes and dehydration.
Individual studies have been unable to prove which hydrating solution is safer when contrast dye is used, so Dr. Sankar D. Navaneethan, a kidney specialist at the Glickman Urological & Kidney Institute at the Cleveland Clinic in Ohio, and co-investigators pooled data from a dozen published clinical trials to clarify this question.
Altogether, 1,854 patients were included in the studies.
The combined results showed that sodium bicarbonate-based hydration solutions cut the risk of nephropathy by more than half, the investigators report. Results were similar for patients who already had decreased kidney function prior to the test. The authors also observed that sodium bicarbonate was safe in patients who had heart disease.
“This is very promising but additional studies are needed to determine the optimal regimen of baking soda that will reduce the need for dialysis,” said Sonal Singh, M.D., M.P.H., an assistant professor of internal medicine at Wake Forest University School of Medicine and a co-author on the study.
The National Kidney Foundation is dedicated to preventing and treating kidney and urinary tract diseases, improving the health and well being of individuals and families affected by these diseases and increasing availability of all organs for transplantation.
To learn more about chronic kidney disease or dialysis contact the National Kidney Foundation at www.kidney.org or (800) 622-9010.
Posted under: Research Studies

http://www.kidney.org/news/newsroom/newsitem.cfm?id=126&&cid=100

[CHeatherS]

Well, I hope this has all been worked out by now..... but you are very wise to be alert ahead of time for this, because it's your body that you care about more than any of those medical folks.  I had a MRI with dye contrast scheduled as well for my transplant workup, and I couldn't get any help up here in Alaska so I called the transplant center in Seattle and they were able to halt the dye part of it.....    Let us know how this all works out dear, and I am praying for you.... blessings!

Heather

[WishIKnew]

After MUCH discussion I had the MRI with dye yesterday at 10 AM and was hooked up at my dialysis center by 11:15.  After all the discussion I was more afraid of the consequences of not finding all of the cancer and dealing with it immediately than of the risk of the dye.  If I made the wrong choice please don't tell me.  I'm doing the best I can and really chose based upon which fear was greater.....

As always, I love your input and information!!!!!  I should get results Monday.....

[Stoday]

When I dialysed after the scan all the gear and fluids were disposed of separately from the rest. They had a special radioactive bag. I think it had to be held for a week or two before the usual incineration. I'm sure the half-life is quite short, so there's hardly any radioactivity left after a week.

[jbeany]

After MUCH discussion I had the MRI with dye yesterday at 10 AM and was hooked up at my dialysis center by 11:15.  After all the discussion I was more afraid of the consequences of not finding all of the cancer and dealing with it immediately than of the risk of the dye.  If I made the wrong choice please don't tell me.  I'm doing the best I can and really chose based upon which fear was greater.....

As always, I love your input and information!!!!!  I should get results Monday.....

Hey, we're all doing the best we can with the information we're given.  That concept of informed consent is great - there are some things that don't really have a best possible choice, and we just have to go with what feels right to us.

Hope your test results come back better than anyone expected!

[Ang]

Ang. I was also under the impression it was bad karma for those with kidney failure/reduced function as well as tx patients.

never ever told that contrast was a no no for dialysis patients

[rocker]

I always ask when there's contrast involved, and I've been told by several people that they want you dialyzed "within 24 hours".  So, that doesn't sound like a terrible hurry to me, but more like a precaution.

[WishIKnew]

Should get results today.......

[billybags]

Fingers crossed for good results. Its horrible waiting for them isn't it.

[okarol]

 

[rsudock]

Diane hoping for good results for you! Please let me know when your surgery is for the cancer and I would be more then happy to come and sit with you in Cleveland...I know we live pretty close together. Trust me we don't have to have some lengthy convo if you are not feeling up to it, we can just sit and watch tv together.

xo,
R

[WishIKnew]

rsudock - you're soooo sweet!  The surgery will probably be in about a month.  I'll be sure to let you know!

Thanks all for your support!

The MRI showed  no additional cancer.  I have an invasive ductal carcinoma, grade 2, malignant, about 1 cm with the scar tissue surrounding it being 3 cm.  I have to make a decision between a lumpectomy and a masectomy.  We meet with an oncologist Friday.  I want someone to coordinate the care between the dialysis and hope for future transplant and the cancer.  I have more questions that answers!

Do you think that a masectomy wiil be a good choice in the long term.  I mean will I have a better chance of getting a transplant if there is no breast tissue left to grow potential new cnacer in?  I want to do whatever is best for the long term of my health and since post transplant drugs increase the risk of cancer?  What do you think?

[billybags]

WishIKnew, which ever way you chose to go, we are all rooting for you. That is so sweet of  rsudock to come and sit with you. if I lived near I would do the same. We could have a virtual sit in.