Cardiac and Kidney Health: Innovative Approach to Address Both

Michael Soltis, a retired executive, had been experiencing difficulties with his kidneys for several years when doctors diagnosed him with heart disease. The conditions may often go together: kidney disease can cause heart problems, and vice versa.

Treating certain heart conditionswhen the patient has kidney issues can be tricky, however. While contrast dye duringimaging helps physicians see how the arteries are functioning and typically guidesinterventions during cardiac catheterization,the dye can be harmful to the kidneys if they are compromised.

Fortunately, interventional cardiologist Phillip Erwin, M.D., PhD,offered Mr. Soltis an alternative at Miami Cardiac & VascularInstitute atSouth Miami Hospital: a multi-stepprocedure that requires only a few tablespoons of dye, versus several cups. It’san uncommon approach Dr. Erwin has been refining for a number of years, hesays.

“Patients shouldn’t have to choose between their heart and their kidneys,” says Dr. Erwin, the hospital’s director of complex coronary and structural intervention. “Through the use of multi-modality imaging, we are able to fix coronary disease without putting the kidneys at risk.”

An Innovative Approach

Mr. Soltis, 79, had received a pacemaker tocontrol an abnormal heart rhythm, but he still was experiencing considerableshortness of breath and angina, chest pain that occurs when narrowed arteries preventenough oxygenated blood from reaching the heart. But because of his advancedkidney disease, he didn’t believe he was a candidate for percutaneousintervention, a minimally invasive procedure to open clogged arteries.

Mr. Soltis says he knew thesituation was dire when he sought help at SouthMiami Hospital. He was relieved to have his condition carefully evaluatedby a multi-disciplinary team of experts, including Dr. Erwin, nephrologist Alberto Esquenazi, M.D. cardiologistElieHaddad, M.D.,  and hospitalists ArielMoses, M.D. and KlitiTane, M.D.

“The doctors all got together andtalked — the cardiologists, the hospitalist and the nephrologist,” Mr. Soltisrecalls. “I liked the idea that the doctors collaborated and came up with aplan to deal with everything, not just one thing. Sometimes doctors rush in todo things and ignore the other problems. I was very happy with how theyapproached my situation.”

Dr. Erwin’s plan to use a minimal amount of dye was designedto put less stress on Mr. Soltis’ kidneys in an effort to save him from havingto go on dialysis as a result of the procedure. “It’s like insteadof using bright headlights to see what is going on, I use night visiongoggles,” Dr. Erwin explains.

Breaking up the intervention intotwo procedures also reduces the load on the kidneys, Dr. Erwin says. “We takethe pictures with a small amount of dye on one day to get an idea of what’sthere, then we send the patient home. We let the kidneys rest and flush out thecontrast agent before we bring the patient back two days later,” he says.

“At that point I don’t need to domore pictures with dye, I already know what it looks like. Because you can seethe calcification under X-ray without using dye, I have landmarks to follow,”says Dr. Erwin. “Using instravascular ultrasound — a small ultrasound camerathat you put inside the vessel — you can see inside and find the blockage.”

With this complex approach, Dr.Erwin succeeded in threading a tiny rotary drill through Mr. Soltis’ bloodvessels to the hardened, cement-like blockage that was impeding his blood flow.Once the artery was cleared, Dr. Erwin put in a stentto support the artery and keep the blood flowing without causing kidney damage.“Everyone expected him to end up on dialysis from this procedure, but becausehis heart’s pumping function improved so robustly immediately after therevascularization, his kidneys rallied. Their function actually improved.”

A grandfather of six teens andyoung adults, Mr. Soltis, 79, is grateful for the skillful care he received.“Dr. Erwin told me how conservative he had been with the dye, and I told him,‘I think you saved my life.’ ”

A Wider Application

Dr. Erwin believes the approach hetook with Mr. Soltis could benefit many.

“There a lot of people with chronickidney disease who forgo treating their angina or coronary artery diseasebecause they fear they are going to end up on dialysis. They suffer a lot,” hesays. “Of course, nobody wants to end up on dialysis. But they have been given afalse choice — ‘If you go to the cath lab, you will end up on dialysis.’ Thatdoesn’t have to be true.”

Preserving the kidneys is key, but addressing cardiac issuesis also important.

 “If you can avoid dialysis and keep thekidneys healthy, that certainly is better for the patient’s lifestyle andhealth,” Dr. Erwin says. “Now we have the opportunity to restore people totheir lives without them paying the tremendous price of losing their kidneyfunction.”