Would you recommend delaying left heart catheterization until development of ESKD in a patient with CKD Stage 5 and stable coronary artery disease given concern for contrast-induced nephropathy?

This is a complicated scenario and one in which there are more factors than just medical ones.

I am far less concerned about contrast nephropathy (even arterial as in this case), compared to a decade ago. The more important question is whether a patient with stable CAD requires a cardiac cath. If th...

If the patient truly has stable CAD then why risk pushing the patient to ESRD by exposing them to contrast when there’s no mortality benefit compared to medical therapy? If the patient has intractable angina, then it becomes more imperative to do a cath at which point it becomes the patient’s decisi...

I would not delay the catheterization. Measures can be taken to minimize contrast nephropathy, and the worse case scenario means accelerating the onset of dialysis whereas delay worse case scenario is acute MI.

I have found that selective arteriography and skipping left ventriculogram typically lead to minimal post-cath issues unless extensive intervention is required.

I will not delay LHC with the patient at risk of a disabling AMI. I will explain thoroughly the risks vs benefits and bring the patient into the equation.

Arturo Medina, MD, FACC

"Shared decision making"