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Wednesday, June 19, 2013
Kidney and Contrast Dye
I am a heart patient (CHf and CAD) with some kidney dysfunction (creatinine around 1.45). Due to heart issues an angiogram might be necessary. I`ve been told the biggest risk I face is damaging my kidneys and kidney failure, due to the contrast dye used. This is enough to make me reconsider the procedure.
How high is the risk of kidney failure and having to go on dialysis given the kidney impairment? I have read that i) hydration ii) low-weight(?) dye, and iii) an antioxidant medicine, help lower this risk - Is there a estimate of how much the risk is reduced? Due to my CHF I am volume restricted, and I assume hydration is tricky, and I`m not sure if the antioxidant medicines are okay with the heart. Are there any other measures that can be taken for my profile to keep my kidneys safe?
Thank you very much for this service.
There is a risk of kidney failure from the procedure.One type of risk is related to the dye and another risk to the procedure itself. First the dye. The lowest risk (for people with preexisting renal impairment) is with non-ionic low osmolality agents and is about 5%. If you are also a diabetic with renal disease then the risk goes to about 10%. However most of this risk represents a transient rise in the creatinine and NOT permanent damage. Hydration and acetylcysteine represent the usual preventive approach.
Talk to your doctor about holding your diuretic a few days prior to the procedure and if you should be given intravenous saline at the time of the procedure. Acetylcysteine(the anti-oxidant) can be given IV or by mouth.
The procedure: Sometimes the insertion of the catheter into an atherosclerotic aorta can dislodge some plaque from the wall of the aorta which can then shower your kidneys. This can cause permanent kidney damage. The risk is less than 1%.
When making your decision consider the risk of NOT DOING the procedure also. If you have coronary artery disease that is treatable,then the procedure could save your life!
Thomas Zipp, MD
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University