about dialysis, but heart related as well

[boswife]

So, is there anything in particular (in light of our friends recient heart attach) that we as dialysis patients should be doing espacially for our hearts?  (or that of our loved ones on dialysis )  I know theirs exercise, diet stuff for dialysis patients, then diabetes, AND heart, well, anything else important we may be missing due to the fact he's on dialysis.

[jbeany]

If you are pre-d and not yet started on the transplant process, you might see if you can get your doc to order the stress test that is the usual requirement for anyone diabetic who wants to go on the list.  If it shows any problem that can be fixed, it could be done and out of the way before you get started with listing.

[galvo]

Keep the 'big three' in order - Calcium, Potassium and Phosphates!

[Jean]

I would strongly suggest NOT getting the stress test, as it is largely inaccurate. Go for the angiogram. If they know there is kidney disease, they pre-admit you so you can get hydrated, and they  use less dye so that there is little if any damage to the kidneys. Yes, it does take the whole day, but so does the stress test. Just my Humble Opinion, since I have just had both tests.

[chook]

And what about the low dose aspirin? Hubby has been taking it for years as has family history of heart problems. I am thinking I might ask the neph about taking it myself. Have just had a stress test and passed with flying colours - less impressed about that after reading Jean's comment.

[Jean]

Sorry about that chook, but you have to know that those stress tests can be startliingly inaccurate for women. My friend had a stress test, they told her she needed open heart surgery. Scared her so bad, she had a stroke that night. I kid you not. Then she had an angio, and it said, nope, she is fine, so which one is right? They say the angio is absolutely correct, but, who knows.

[chook]

Jean, good to know. Will watch the diet and keep up the bike riding!!

[paris]

Jean, are saying both the nuclear stress test and the treadmill test?    I have had both and an echocardiogram.  With the echo, they showed me each valve, all the chambers, etc.  It is noninvasive and can give a lot of information and takes little time.    I hope the nuclear stress test is correct at least some of the time --- it is expensive and takes a while.   Anyone have more information?   This has made me very curious.

Keep the 'big three' in order - Calcium, Potassium and Phosphates!

You are so right, Galvo.   Especially, the potassium and the heart.

[Marina]

I  agreee  with  keeping  an  eye  on potassium  since  high  levels  can  stop the  heart.
Keep  phosphorous in  the  low to  mid  3'
Elevated  phosphorus  levels  can  affect  the  cardiovascular  system in  big  ways.
A  study  showed  that  people  who  keep  phos  in the mid  3's  will  longer  than  those  who  keep it in the  mid  to  high  4's.

I  also  had  a  stress  test,  everything  looked  fine,  but  on the  angio  cath  required  for  TX  it  showed  I have  70's  blockages  (due to  diabetes).   

[kristina]

And what about the low dose aspirin? Hubby has been taking it for years as has family history of heart problems. I am thinking I might ask the neph about taking it myself. Have just had a stress test and passed with flying colours - less impressed about that after reading Jean's comment.

I have been wondering about Aspirin...
There seems to be some medical controversy about it.

Doctors following the guidelines for treatment often prescribe Aspirin
but it seems to be coming out in the News that Aspirin is causing problems after long-term use.

Whether this has any basis in fact I don’t know, but there seems to be cause for concern.
Could it be long-term-use thins the blood and causes bleeding?

It seems so difficult to know what is best, particularly with patients who have had a stroke
and have been prescribed daily Aspirin...

[Nephrologista]

Jean, are saying both the nuclear stress test and the treadmill test?    I have had both and an echocardiogram.  With the echo, they showed me each valve, all the chambers, etc.  It is noninvasive and can give a lot of information and takes little time.    I hope the nuclear stress test is correct at least some of the time --- it is expensive and takes a while.   Anyone have more information?   This has made me very curious.

Keep the 'big three' in order - Calcium, Potassium and Phosphates!

You are so right, Galvo.   Especially, the potassium and the heart.

The tests really look at different things.  Echocardiograms give you information about the structure of the heart - muscle enlargement, valve disease, fluid collections.  There are stress echos, which look at the motion of the heart muscle.  If there's poor blood flow to one region of the heart (which would be caused by a blockage in one of the coronary arteries) the muscle in that region might start to move differently as the heart works harder.

Nuclear stress tests look at how well the heart muscle is supplied with blood.  The nuclear tracer is injected into the blood, so where there's more blood flow, there will be more tracer signal.  A region of the heart that doesn't get good blood flow won't light up as much.

An angiogram threads a catheter directly into the coronary arteries (the blood vessels that supply blood to the heart muscle) and injects dye to see the interior of the arteries.  It's a more direct way to look at the arteries, so more specific than a stress test.  But it's also invasive, and the dye is kidney toxic.

The one real "blind spot" for stress tests is a blockage in the left main artery - the "widowmaker."  That artery is very short before it branches into different arteries, but it supplies the entire left ventricle.  If there's a near-blockage there, blood flow to the entire ventricle can be compromised.  Then there won't be any one area of the heart that stands out - it will be a global depression, and that's not nearly as easy to see.  The tests are such that it's hard to compare images from different times.  Fortunately, left main lesions aren't as common.  They can't be stented - it's an automatic bypass surgery.

[MooseMom]

Kristina, every medication has side effects, even aspirin.  Low dose aspirin is helpful in thinning the blood when thinning the blood is an appropriate course of action.  In people with CKD, high blood lipids are a part of the disease, making us more suceptible to cardiovascular problems, so thinning the blood is a preventative measure for us.  But if you have stomach ulcers or any other kind of blood clotting disorder, then aspirin may be wrong for you.  I know in my case, it makes me bruise much more easily; after a session of cutting back my blackberry bushes, I look like something out of Saw 8, arms bloodied by blackberry thorns.  You're right... it is hard to know what to do. 

[MooseMom]

Nephrologista, I think I'm confused by some of the terms used when describing cardiovascular tests.  I had an "adenosine stress test" as part of my pre-transplant evaluation.  Is this the same as what you would call a "nuclear stress test"?