Swelling and Cardiothoracic Ratio

Ask Our Experts Dr. John Agar, Nephrologist
1

Hi,

My mother has been having swelling in her feet. Her CRT ratio is at 47.4%.

  1. Does swelling automatically mean that you need to lower your dry weight?
  2. My understanding is that a CRT ration under 50% is considered normal. So does that mean that
    she does not need to lower her dry weight even though there is swelling?
  3. I am loathe to lower the dry weight since she has problems with low blood pressure during dialysis.

Thank you.

2

This is far too hard to answer without knowing much, much more about your mother than I could know by means of an internet question, even if I were to ask for more information. So, I am sorry to disappoint but I dont think I could do justice to your mother by trying this one.

In broad terms - and the reason for my reticence - no, swelling of her ankles may be caused by many things. One of these - and perhaps the most common - would be fluid overload and a need to lower dry weight but it is by no means the only possibility and her physician is the appropriate person to advise this. See her doctor for advice.

A ‘normal’ CRT is about the ‘bluntest’ possible tool to assess the heart that I know. There are far more effective and sophisticated ways to know whether her heart is at issue … and I would not walk away content just because the CRT is <50%. Again, she needs a cardiological assessment to decide that - not just a plain xray and a pat on the back that all is well because the CRT is normal.

Though my guess might be that her dry weight does need to come down, this is a guess from far away, made with little or no information and absolutely no knowledge of your mother as an individual and/or of her past and present medical state. A low BP during dialysis also has many causes and only her physician can know all of these issues and deal with them wisely.

Sorry to be such a dead loss to you on this one Muraiken but, this time, your mother needs a medical review, not an internet question.