First a little background. My 46-YO husband Charles is a Type I diabetic of 33 years duration. Five years ago, he had a significant MI which left him disabled. Because his disease was of a diffuse nature, we were told at the time that bypass/angioplasty was not an option, and he was treated medically. However, over the past year, since Charles began peritoneal dialysis, his angina significantly worsened becoming extremely unstable even with maximum medical management. Upon re-evaluation, his new cardiologist recommended a more aggressive approach. Results of a new cath showed a 100% blockage of the LAD, 70-80% blockage of the obtuse marginal, and 70% blockage of the right coronary artery, which in his case is dominant. All of these blockages involve long stenosises into diffusely diseased smaller arteries. After considerable search, our cardiologist located a brave surgeon who was will to attempt bypass of the two partially blocked vessels with TMR for areas that could not be bypassed. During surgery, only the obtuse marginal vessel was successfully bypassed (not a great bypass we're told, but a bypass)and 32 laser holes were placed in the left ventrical. Charles barely survived the surgery, and afterwards we were told that what had been done was roughly the equivalent of putting a bandaid on a knife wound. Still, three weeks post-op his is angina-free so far, and we are optimistic about quality of life at least.
Which (finally) leads me to my question. We have been told by more than one nephrologist doctors that because of his medical history--particularly his heart problems--that statistically Charles' odds of long-term survival on dialysis are poor. (About 50% in three years.) We know that dialysis patients seem to have a higher rate of progression of coronary artery disease. What we don't understand is, why? What causes dialysis patients to do so poorly heart-wise? And is there anything we can do to improve Charles' odds? Given his heart problems, we're told kidney transplant is absolutely not an option, but we're willing to do whatever we can to keep him as healthy as possible as long as possible. Charles is an amazing person with an incredibly positive attitude, but sometimes this feels like a dark cloud hanging over our lives.
I'm sorry this has been so long-winded. Thank you so much for your answer. Though Charles has wonderful doctors, they are often so busy that it's hard to stop them long enough to ask this kind of question. God bless you.
Unfortunately, your nephrologist is correct, that the long-term survival of a diabetic with severe heart disease on dialysis is not good. The primary culprit is likely the diabetes, which lead to both the heart and kidney problems. The fact that he is on dialysis is a marker of greater severity of diabetes, and this is why his coronary artery disease is so aggressive. Strict control of his diabetes and cholesterol would be a good idea. Newer therapies, such as gene therapy, are being investigated and will hopefully come to fruition in time to benefit your husband.
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