Angiogram - Risks of kidney failure?

My father is 80 years old. He has diabetes, and kidney problems (his kidney function is only around 25%). About a year and a half ago, he had an angiogram done, which indicated 2 blockages (one in the front and one in the back of the heart). At the time, an angioplasty wasn't possible, and the recommendation was to use medication, and if the condition gets worse by-pass surgery should be considered.

He's now experiencing more shortness of breath in walking, and his left arm feels a little numb. The cardiologist suggests an angiogram be done now, with the warning that the kidney function may worsen, and he might even require dialysis for life. His nephrologist said that there are procedures that can protect the kidney for the angiogram, and recommended he go ahead with the angiogram.

Any comments on what he should consider would be very much appreciated.

Your Dad's interventionalist cardiologist is acutely aware of exactly what your Dad's kidney function is. There is a general rule that the amount of dye used during a cath should be limited to the estimated GFR (if your Dad's GFR is 30, then no more than 30mL of dye should be used). Its a rule of thumb - my point is that cardiologists obsess over renal function with cardiac caths.

Can something be done? Sure there are bicarb and pre-hydration protocols used for patients who have acute and chronic kidney failure - prior to a cath. The other possiblility of using CT angiogram requires dye as well, so there is no real benefit to that over the cardiac cath in terms of renal function. With the aforementioned protocol we have had excellent results regarding renal function. I can not think of a single patient that had worse renal function after a cath - if we employed those protocols. (among thousands of patients) There are some very good studies supporting the protocol's use in these cases.

It will be necessary to quantify the extent of and location of disease - even if they are planning a potential bypass. (They also will check the mammary artery to make sure it is flowing. It is an artery that runs inside the chest wall and is borrowed as a vessel for bypass)

Given your Dad's other health issues and advanced age - surgery will not be easy on him. It is something to consider long and hard before doing.

In fact, given that a possible by-pass is a very big deal, perhaps before a cath is ever attempted, your Dad should get a consult with a cardiothoracic surgeon regarding his prognosis for an open heart surgery

After all, they said before that their only option was to do a by-pass if things got worse, right? So logic would dictate that they are seriously considering a by-pass now. Wouldn 't it make sense to know if your Dad was even a candidate for such a surgery? If not then why would you proceed with the cath and risk renal function? Also it is important to know if your Dad WANTS the surgery after he knows the details?

Lastly you need to remember that the cath and possible subsequent angioplasty is to address symptoms - not necessarily prolong life. If the symptoms are really intolerable then perhaps consideration of alternative treatments - like narcotics and/or other novel treatments - click on the links below for more information. Some may or may not be appropriate for your Father.

http://www.ispub.com/ostia/index.php?xml...
http://www.medscape.com/viewarticle/4064...
http://heartdisease.about.com/cs/coronar...
http://www.ranexa.com/home.html

It might be worth getting a full copy of this journal article from your local hospital's library.
http://www.ncbi.nlm.nih.gov/entrez/query...
I hope these thoughts help. Good luck. My best to your Dad.

The contrast dye injected during angiogram can harm the kidneys. Let your dad's cardiologist know about you dad's renal failure so they can take precaution. I have seen patient's who had renal insufficiency due to contrast dye. It is better that he go ahead with the angiogram. Changes are the blockages are also affecting the kidneys function. There is no enough blood going through the kidneys because the heart is not functioning properly.

The contrast material could damage the kidneys (particularly in patients with diabetes). Relative contraindications to cardiac catheterization include renal insufficiency, coagulopathy, fever, systemic infection, uncontrolled arrhythmia or hypertension, uncompensated heart failure, and radiopaque dye allergies in patients who have not been appropriately premedicated.
Please see the web pages for more details on Coronary angiography.

I think you should ask your cardiac surgeon to include your nephrologist in his team so that both can sort out the problem. This is the best possible professional recommendation that I can give.
My prayers for your father's safe recovery.