Good news for the patients with kidney disease and low renal function. Dr Asrar ul Haq performs ultra-low (<10 ml) contrast stent procedure using intravascular ultrasound (IVUS), in a patient with eGFR of 9, and after being declined alternate therapies due to risk of kidney function deterioration. Only 3 ml of contrast was used during the procedure, saving the patient from open heart surgery and preventing the need for dialysis.
When cardiologists look at your blood vessels with an imaging test, they need to inject a dye. It helps them to see the exact site of blocked blood vessel. Cardiologists also use contrast dye during stent procedures so they can see the blood vessels they are treating.
Angiographic dye has been known to cause worsening renal function in patients with underlying kidney disease. It is a serious problem and limits the quality of treatment that can be given to patients with kidney disease. This is known as “contrast induced nephropathy (CIN).” About 1% to 3% of people who receive these special dyes develop changes in their kidney function. Anyone can get CIN, but those at the greatest risk have underlying kidney disease. Additional risk factors are diabetes (particularly in those who have kidney disease), the elderly, and chronic heart failure.
If you are at increased risk, what will doctors do differently?
In you are at higher risk for CIN, different dyes might be used. These dyes are less dense then others. Dyes should be used in the smallest possible amounts.
To prepare for the procedure, fluids may be given through a vein for several hours before the test.
You might be asked to not take certain medicines before and after the procedure.
If a second contrast-dye procedure is needed, it might be delayed for a while to make sure your kidneys are ready for another exposure to dye.
If doctors need to look at your blood vessels, the risk of CIN shouldn't stop the procedure as the risk of not treating your heart may be worse. If you have coronary artery disease that is treatable, in expert hands, these procedures can make a big difference.
Most important, talk to your health care team about your kidneys when they are planning to do a procedure using contrast dyes.
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