In your opinion?

  I am a caregiver to a 43 year old caucasian male. He is a Type I Diabetic with ESRD and hemodialysis. Previous Kidney transplant that went into failure 1 yr ago. He had a cardiac cath last winter that showed scattered disease that required no treatment. His EF was 61%. He has a history of hypertension, diabetes - type I, high cholesterol, depression and gastroparesis. Previous history - alcoholism. He most recent phosphorus  He had a PET scan with adenosine this week that showed his EF was 35%.An echocardiogram was done today to verify the EF. He is presently being cleared for surgery for kidney transplant at a local University Hospital.. He also has a phosphorus 8.8, PTH 606, Potassium 5.7, and A1c of 6.11. His medications include: Lantus, Novolog, Sensipar 30 mg QD, Favorit vitamin, Effexor 150 mg QD, Effexor 75 mg QD, EC ASA 325 mg QD, Furosemide 160 mg BID, Hydralazine 10 mg TID, Pravastatin 40 mg QD,  Norvasc 10 mg BID, Protonix 40 mg QD, Metoclopramide 10 mg QID, Metoprolol 100 mg BID, Catapres Patch 0.1 mg weekly, Seroquel 50 mg HS, Ambien 10 mg HS.
   He has recently had exertional dyspnea. While off of his Lasix, he had peripheral edema and nocturnal dypsnea. His blood pressure this week 161/90.
   In your experience, would he be a good candidate for kidney transplant?
  

[Douglas Bogart, MD]

It would be important to know why his left ventricular function worsened--was it due to uncontrolled blood pressure or the development of coronary artery disease.  I suspect they will want to resolve this issue before considering a transplant.