How save is the dye used in an angiogram ?

[kristina]

The protocol for transplant includes a pre-transplant coronary angiogram for the examination of blood vessels to the heart
which I am told is standard procedure to make sure there is no narrowing of the vessels or heart disease that may need treatment before a transplant.
I remember reading that someone had this procedure which uses a special dye and their remaining kidney function deteriorated instantly because of the dye
and they had to be put on dialysis straight away.
... My question is: was that bad luck or does it happen more often that the dye always acts to destroy the remaining kidney function in ESRF?
I have also heard that the latest dye used is very much more safe for the patient and the remaining kidney function. How true is that?

I also have been told that because my kidney function is so low at around 6% that it most likely would be necessary to have two weeks of dialysis prior to the transplant
in order that my blood is brought into a much better condition...

I wonder if the two weeks of dialysis might weaken me and this might nullify the benefit of more healthy blood just before a transplant?

Thank you from Kristina.

[Michael Murphy]

After a accident in 2012 I was scheduled for rotor cuff surgery.  I was told that prior to the surgery I had to have a angiogram. At the time I was just at the cusp of needing dialysis.  They checked my kidney function before and after the angioplasty.  No change.  However due to my kidney problems the heart doctor used only 20 cc of contrast dye.  5 years ago the same surgeon went uh oh when he first saw the X-ray of my heart. Not a good feeling to hear when you are laying awake for the procedure.  However after the doctor was done he was running around showing everyone the final X-ray like he won the Super Bowl. We'll after the last angioplasty he did the same thing only this time he was running around showing what he got with 20 cc of contrast.

[kristina]

Thank you Michael.
Very interesting! I am glad that the contrast dye did not influence your kidney function.
Since you were given 20 cc (looks like a lot) because of your kidney problems,
I wonder whether you, or anyone else would know what the normal amount (cc) would be?

P.S. I believe one's body-weight is also brought into the calculation of the amount of contrast dye given.
I weigh between 55.5 kg and 56 kg. Would you weigh more or less? I am just trying to get an idea of proportion...

Thanks again from Kristina.

[cattlekid]

I had one angioplasty and one angiogram while I was on dialysis.  Both times, I was scheduled for dialysis immediately after the procedure.  With the angiogram, because there was time (the angioplasty was emergency), I also got a bicarb IV ahead of time to protect the kidneys. 

[kristina]

Many thanks cattlekid.

The bicarb IV is very interesting and I shall ask the nephrologist about this.
Maybe bicarb IV is a good idea in combination with the lower amount of contrast dye as mentioned by Michael
and perhaps that may be a help to preserve the little kidney function I have left ...

Thanks again from Kristina.

[amanda100wilson]

Kristina, this is something that definately needs to be discussed with your doctor before the procedure.  I believe you are on dialysis now?  Whenever I have had a procedure involving dye, I have had to dialyze straight after.  I always make a point of checking what contrast they are using, to make sure that it isn't gadolinium, since this can cause nephrogenic systemic fibrosis in those with CKD/ESRD. 

[kristina]

Hello Amanda,
Thanks for the information about gadolinium, I shall ask the medical team about that...
... I am not on dialysis yet and try very hard to keep my "two little fighters" functioning for as long as possible,
whilst getting evaluated for a transplant.
Fortunately I have no ESRF-symptoms yet (touch wood...) no swelling of my ankles and no other ESRF-symptoms.
... My appetite is still normal and I still keep strictly to my vegetarian ESRF-friendly diet... I still go for my daily walks
 and drink little less than 2 litres of (filtered) water every day...

Thanks again from Kristina.

[Speedy1wrc]

I've had several episodes with dye. Also times when they chose not to use it. Different Dr's different circumstances. The last time was like you, for a workup for transplant. The Dr ( no longer my Dr) sxeheduled it with dye. I mentioned my concern and she said my kidney function was so low it didn't matter. As I said, I am no longer with that Dr.

They didn't do a comparative before and after, so I don't know if there was any harm. At the same time though my kidney function was plummeting.

[kristina]

Thanks Speedy.

I am so sorry about your experience with this doctor... and her poor attitude...
... some people just have no idea how hard we try to keep our kidneys functioning...
... no kidney function is ever too low and kidney function should always be respected... even if it is very low...

Thanks for your information, Kristina.

[marlinfshr]

That dye is what put me on dialysis. I was having a heart attack and needed it done ASAP so there wasn't much time to think. My kidneys were weakened years earlier due to chemotheropy (cysplatinum I think). The dye took them down to 8% from the 20% or so they were holding at for years. That was April 2013. My kidneys are still functioning though and I only do to short manual exchanges (CAPD) per day and don't need to remove any fluid. My anemia has improved as well, almost to what it was before. I would like to keep this function as long as possible and am scared about having to have that process done again but so far so good!

[kristina]

Hello marlinfhsr and thanks for your  reply.

It sure is difficult to keep our little kidney function going. Thanks for pointing out the problem with the contrast liquid
and I am very sorry that it has put you on dialysis. I suppose we all react slightly differently,
but nevertheless it is a concern, what effect it may have on our remaining kidney function.

Someone may correct me if I am wrong but I believe Iodine is one of the main components of a particular type of contrast liquid
used for angiogram etc., and it is the Iodine which gets into the glomeruli and may have some level of detrimental effect.

Thanks again from Kristina.

[Michael Murphy]

Now that I am on dialysis I treasure the kidney function I have left.  I know how lucky that small amount of function makes me.  While I need dialysis for getting creatine out of my blood the two little darlings are sill eliminating all the water I drink.  Plus while I try to follow a renal diet I still have pizza once a week and I don't have to take binders.  If a doctor suggested to me my remaining function was not important I don't know what I would do.  At the very least I would point out what kind of a incompetent boob he/she was.  I am not looking forward to my kidneys shutting down and I don't need a quack to hurry the day.

[kristina]

I agree with you, Michael and I do hope your "two little darlings" keep going
and let you enjoy your weekly treat for a very long time to come...
... I noticed that some people, even doctors did not understand why I am fighting with such a determination
to keep my "two little fighters" functioning for as long as possible...
... but there again... healthy people often don't even realize how lucky they are to be without any health problems...

Kind regards from Kristina.

[obsidianom]

I wont let anyone use dye on my wife. No fistulagrams etc. I want to protect her remaining kidney function. Dialysis is easier on the body when there is still residual function. I am tired of doctors doing tests all the time "just to check' . Too much dye and too many worthless tests are done.

[kristina]

Thank you obsidianom.

I fully appreciate and share your reservations concerning the use of a contrast dye, but if the protocol of the “transplant team” is,
that patients should undergo an angiogram to establish whether their heart, surrounding arteries and veins are healthy enough
to withstand the serious operation of a transplant, would you still refuse such an angiogram with contrast dye?
This is a very important question because I too do not like the idea of a contrast liquid causing further possible problems for my small kidney function.

Thanks again from Kristina.

[lainiepop]

Kristina which transplant team are you under? I didn't have an angiogram for my tx workup, all i had was ecg, blood tests and the ct scans oh and chest x-ray. My dad was the same and he was the donor, but he did have a heart attack a yer later but us fine now. I asked whether the angiogram should be done for donors they said they dont do them for anyone unless showing signs of heart disease such as high blood pressure and high cholestrol as they are so expensive, but as he was over 65 perhaps they should have. But he has had a heart bypass now and is healthy and his kidney is fine, he obviously had the angiogram when he had the heart attack and they warned him about the dye as he only had the one kidney now but obviously that kidney is normal. Do they absolutely have to do it? I dont know if i didnt have it because i was 30, but then hey this kidney could last 20 yrs then i have a heart attack u know? I did ask my kidney specialsts about a test for me when dad had the heart attack in case it was genetic and they looked at me in horror and said they would never risk the tx (and particularly a well functioning one) on an off chance that it might be genetic and i might have issues later and told me to avoid the dye. They said i have normal bp and cholestrol so it would be daft to do it, obviously i dont know your personal medical situation but an angiogram was not protcol at my centre in the uk, or not for me. Unless it is when u reach a certain age but i dont know your age. Tbh I agree with Obsidianom, be protective about what function u have left as the doctors wont be especially at your stage, i found this, to me it was a big deal if i had to dialyze before dad was approved to donate, to them it was like whatever it will happen anyway you know? Fortunately it didnt, and a few doctors luckily agreed and pushed the tx forward as they wanted it pre-emptive. I have also found throughout this journey, you need to be pro-active and take responsibility (wrongly in my opinion!) for your own care. In reality how long do they expect u to be off dialysis for, could it wait til then if it has to be done? Bear in mind they told me id be on it in weks and 9mths later i still had the same gfr and felt fine no symptoms like you, in fact the morning of the transplant i asked where the toilet was and a doctor told me they're for patients not visitors, um im having a tx in 2 hrs i am the patient!! I would talk to them, express your concerns and try and reach a compromise if it hs to be done, like less dye.  xxx

[kristina]

Hello Iainiepop
Thanks for your in depths reply, you have had a quite an extraordinary journey yourself
and  I am very glad you are doing so well.
I take all your points on board and tread a careful path as best as I can.
I had quite a complicated health history, having first experienced complete renal failure (with uraemia and coma) in 1971,
but fortunately I got through this to slowly recover my kidney function, which, after some years, settled at around 40%,
and from this time until now I suffered two cerebral haemorrhages and much later a stroke
and once again I came through these catastrophies with only very slight legacies.
I also have suffered all my life with inherited Systemic Lupus Erythematosus (SLE), which was in 2003 upgraded to added Mixed Connective Tissue Disease (MCTD) and other diseases like Vasculitis, Sjoegren's, Sicca, Antiphospholipid Syndrome, Hypertension etc.
I mention all this because there may be a genuine reason for the suggestion I have an angiogram...
But, I shall definitely argue my corner, because I am very, very protective of my “two little fighters”
which are still functioning alright, even though they are feeling very poorly...

[cdwbrooklyn]

Now that I am on dialysis I treasure the kidney function I have left.  I know how lucky that small amount of function makes me.  While I need dialysis for getting creatine out of my blood the two little darlings are sill eliminating all the water I drink.  Plus while I try to follow a renal diet I still have pizza once a week and I don't have to take binders.  If a doctor suggested to me my remaining function was not important I don't know what I would do.  At the very least I would point out what kind of a incompetent boob he/she was.  I am not looking forward to my kidneys shutting down and I don't need a quack to hurry the day.

I feel just like you. 

[lainiepop]

Ok kristina i can ses why they might want to do it, but i hope they do it in a way which will preserve your kidney function. I totally understand u wanting to hang on to the function as i was and would be the same, unfortunately  dont think doctors get that

[kristina]

Thank you Iainiepop.

It is a hazardous and complicated journey for us all, I think
and I do appreciate your thoughts.

Best wishes and thanks again from Kristina.

[Sugarlump]

I recently had an angiogram.
I was told their are two strengths of dye depending on kidney function (they used the lowest one for me)
I also had dialysis immediately after but
I was allergic to the dye!! Very itchy rash appeared within 24 hours that really drove me crazy for a week!And a raised temperature on and off...
Apparently an allergic reaction is quite common!

I wouldn't have another unless it was a life or death situation. 

[kristina]

Thanks sugarlump.
I shall ask the nephrologist, how important an angiogram is for me and
I shall tell him, that I really need to be convinced, because I suffer ever so easily from all sorts of allergies myself.
No point in risking so much at such a late stage, when I have done so well so far...
Thanks a lot for pointing this out to me.
Kind regards from Kristina.

[LisaBart]

My husband  needed to have his fistula repaired a few months back and was given the option to have it patched (taking a vein from his groin to do so)
or dye & stent, he opted for the patching so they didnt need to use dye as the surgeon said it may be detrimental to his remaining kidney function, (8-9%)
Anyway, the patch failed and a month later they stented it anyway! He is currently at 7%, and still denying he needs dialysis...he does have times of the day that he vomits,
and a few days where he feels very very bad, he is sleeping lots (day) and needing sleeping tablets at night for a decent sleep...
He has lost interest in doing muh for me at home...even the dishes!!!
He has had angiograms in the past....and 5 years ago had a 5 way heart by-pass, he was probably at about 20% functron then, but he felt loads better and went back to work...for a time.

[kristina]

Thank you for your kind message LisaBart.
I am very sorry for the experiences your husband has gone through and I don’t blame him for his reservations ...
...Like your husband, I have gone through some good medical experiences (which accounts for the fact that I am still alive...)
and some extremely bad medical experiences (which have damaged and badly hurt me on more than one occasion
with two cerebral haemorrhages, chronic osteomyelitis: my foot was saved at the last minute..., a severe stroke and end stage kidney failure ...)
...and because of these experiences, I naturally fear dialysis and/or transplant. Not because of the procedures as such,
but because there are medics, who couldn’t care less and don’t seem to be bothered whether a patient lives or dies...
... and as a result of this attitude, not enough medical care is taken...
Once a patient becomes aware of these facts, reservations about medical procedures are being developed and very hard “to get rid off”...
...and some doctors are fully aware of these reservations ... and that gives some of them an enormous feeling of power
and unfortunately it “goes to their head sometimes”...and as a result, the patient may be given a chance... or they may not be given a chance...
... Another problem is, that it is very hard for some vulnerable patients, who have been badly hurt, to locate a doctor who is actually prepared to listen to the patient
and take into account the patient’s medical allergies and intolerances to many medications...and that again can make survival a bit tricky...
I do understand your husband’s reservation and I do hope, the two of you can locate trustable medics for his treatment...
... to receive proper medical care for your husband from then on ...

Good luck and best wishes from Kristina.

[LisaBart]

You have had a terrible time
I wasn't impressed with previous nephrologist (1.5 hrs away) here and was pleased to be moved on to the local renal unit nephrologists,
a lovely team of three, all have their different opinions but none are pushy and all ask questions and also listen. The nursing team are also lovely and we have all made friends over the
past year...the nurses rub their hands together when husband comes to his appointments and ask if he is now ready to join them...they joke with him to put him at ease...
at Christmas time I dropped them in a big xmas flower arrangement for their kindness...
I hope you find someone as lovely to deal with.