Tests and procedures pre-transplant will push me onto dialysis

[Fisherman]

  I'm going through eval for transplant, but they want to fix an abdominal aortic aneurysm that wouldn't have to be fixed for another 3-5 years if i wasnt being consider for a transplant.   I'm not on dialysis yet, but will be after the aneurysm surgery because they use a contrast dye and the surgery has some risk to it..  It seems like I'm damned if I do and damned if I don't.  Not sure if I should wait until the nephrologist says dialysis is imminent or move forward now knowing that I'll be on dialysis right away.

[coravh]

Did they tell you that they guarantee you will be on dialysis with the dye? There are different classes of contrast dyes and some are more renal friendly than others (but more expensive). I did have some contrast pre dialysis but I don't remember at what stage my kidneys were. They were already damaged, but I don't remember by how much. But the dye did not further damage my kidneys. They gave me a lot of iv hydration before hand and I was ok.

[jeannea]

Have you discussed your fears with the doctors? It could be there is something they could do to minimize the risk. It's worth asking. That aneurysm would scare me and I would want it out. Do they really just let those go for years? I'm surprised.

[Fisherman]

Thanks for the input about the contrast dye.  Some docs act like its a given that it would put me on dialysis.  They don't fix this kind aneurysms until they are 5.5 cams because the risk of death from surgery is higher than the risk of it bursting at this point.  mine is 4.4 now.  Doc estimated that it will have to be done in 3-5 years anyway.  Vascular surgeon thinks there is no doubt about dialysis after the aneurysm surgery, but transplant surgeon is more optimistic.  The risk involved in the surgery is another concern.  It's a big decision.  My GFR was 16 in August.  Thinking I might wait til it is lower.

[obsidianom]

Have you asked about N acetyl L cysteine? It is worth asking about to protect kidneys. Here is an article on the subject.


Current concepts of contrast-induced nephropathy: A brief review.

Chang CF, Lin CC.


Source

Division of Nephrology, Department of Medicine, Taipei City Hospital-Heping Branch, Taiwan, ROC; National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.


Abstract


Contrast-induced nephropathy (CIN) is a common hospital-acquired acute kidney injury. Published studies on this condition have dramatically increased in recent years. This article aims to provide a brief literature review. English articles published from 1983 to 2012 were retrieved from PubMed by searching using the term "contrast-induced nephropathy." Patients with CIN were associated with increased resource utilization, prolonged hospital stay, and increased long-term mortality. CIN is defined as a ≥0.5 mg/dL rise in serum creatinine or a 25% increase, assessed within 48-72 hours after administration of contrast medium (CM). All patients receiving CM should be evaluated for their CIN risk, especially preexisting kidney disease. The CM should be prewarmed to 37 °C and injected at the lowest possible dose. Repeat injection within 72 hours should be avoided. Either iso-osmolar CM or low-osmolar CM, except ioxaglate or iohexol, can be used in all patients. Iso-osmolar CM iodixanol may be a better choice for high-risk patients with chronic kidney disease requiring intra-arterial administration. Nephrotoxic drugs should be stopped 2 days prior to when the patient undergoes a procedure. All patients receiving CM should be at an optimal volume status. Parenteral isotonic saline without any diuretic should be started 12 hours prior to CM at a rate of 1 mL/kg/h and continued for 24 hours if there is no contraindication. In patients who require shorter volume supplement periods or are at a higher risk, bicarbonate infusion (154 mEq/L, 3 mL/kg/h for 1 hour bolus prior to CM, followed by 1 mL/kg/h for 6 hours) may be used as an alternative to isotonic saline. Oral N-acetylcysteine (600 mg bid, starting on the day prior to the procedure) together with parenteral hydration is suggested for patients at risk. Hemodialysis/hemofiltration is only considered in chronic kidney disease stage 4/5 patients when an access is available. The other medications or techniques for reducing CIN risk are still unclear. CIN is a potentially preventable clinical condition. A careful review of published reports gives us a deeper understanding of CIN and a greater chance of decreasing its risk.

Copyright © 2013. Published by Elsevier B.V.


KEYWORDS:

N-acetylcysteine, contrast media, contrast-induced acute kidney injury, contrast-induced nephropathy, coronary angiography
bout  N acetyl L cysteine for renal prtection.
Here is an article on that subject.

[Deanne]

How long is the wait list time where you are? I think this would affect my decision. If you live in a place with a long wait time, would they be willing to list you and put you on inactive status so you can accrue time while you handle this? 

[coravh]

Just wanted to add that I was given Mucomyst to help protect my kidneys. I couldn't remember the name and had to do some fancy googling, but this is the stuff.

[Fisherman]

All kinds of new barriers to transplant have popped up.  Now they're saying that I have to have one of my kidneys removed because of a small benign cyst.  Then  theres the  aneurysm,   Beginning to think the risks involved in the surgeries are not worth it when there is no guarantee that they will even put me on the transplant list. 

[Deanne]

I understand the frustration. They made me have my gallbladder removed, start a 9-month course of TB treatment, and were questioning my pancreas because of a couple of small cysts in it. I'm finally back on Active status and hoping they call soon before they discover anything else to make me do.