Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: patient recorded as having no known allergies to drugs attending: chief complaint: "my fistula wasn't flowing right." major surgical or invasive procedure: left av venogram left av thrombectomy history of present illness: yom w/pmhx significant for cad, chf, cabg, htn, atrial fibrilliation, ventricular brady-paced, hyperlipidemia renal ca, s/p left nephrectomy in esrd, hd dependent who presented to the 24hrs prior via his dialysis clinic. . daughter reports weakness of the extremities over the weekend following fri hd c/w previous episodes of hyperkalemia. he then presented this mon for regularly scheduled hd per mwf schedule through left arm av graft which was complicated my apparent clot of the graft. . pt was then sent to the for hd. on arrival at the pt was noted to have hyperkalemia w/k of 8.1. he received calclium gluconate, insulin and bicarbonate for correction of hyperkalemia. pt was admitted to the icu and femoral access was obtained for hd and was subsequently dialysed via the femoral access. on hospital day two patient was taken to the interventional suite and clot lysis was attempted without apparent success. pt was then evaluated by the vascular surgery team and planned for transfer to medicine. past medical history: past medical history: #. p-mibi (): new fixed small severe defect in the pda territory, new transient cavity dilation, and an old fixed small moderate defect in the distal lad territory #. cardiac catheterization w/l main and 3 vessel dz w/ patent lima to lad w/ 70% stenosis in distal lad, patent svg to diagnoal ramus w/ 50% stenosis in native diagonal branch, patent svg to om1/om2 but occluded om1 at touchdown. s/p unsuccessful ptca of lm, moderate right and left ventricular diastolic dysfunction #. chf: echo () ef 30-35%, + mr, 2+ tr, moderate pulmonary artery systolic htn #. htn #. hypercholesterolemia #. reportedly small asd on a tee #. esrd, on hd (since ) mwf evenings via left arm av graft (evening shift at , ) #. chronic anemia associated w/ renal failure #. renal cell carcinoma, s/p left nephrectomy #. gout w/flairs 1-2x/mo #. s/p turp for bph #. bilateral cataracts #. left hydrocele w/ hydrocelectomy #. multiple episodes of sob . pshx: #. right common femoral artery thrombus s/p cath in #. pacemaker placement trahy-brady syndrome , w/replacement #. cad s/p 5-vessel cabg (lima-lad, svg-d1, svg-ri, svg-om1, svg-om2) #. left cea (s/p tia) #. thrombectomy and revision of lue av graft w/multiple interventions to graft in the past. social history: he lives alone in . recently retired fully from selling furniture, pt had reduced from full time work to part time work over the past year. + tob: cigar/pipe smoking, daily x20-25 years w/cessation 20yrs prior - etoh - illicit/recreational drug use family history: daughter with mi in mid-40s, had type 1 dm, deceased 56y/o brother w/heart disease, ?mi. + hypertension, + diabetes mellitus, brother w/lymphoma, ? question liver ca physical exam: vitals: t=96.1; hr=70; bp=90/48; rr=20; o2sat=98% ra general: a/o x 3. nad. heent: nc/at, mmm, scar c/w previous cea cv: s1=s2, with grade ii/vi soft systolic murmur heard best at apex, no rubs or gallops appreciated pulm: cta bilaterally, no rhonchi, wheezes or crackles abd: soft, nt/nd with normoactive bs. ext: no cyanosis, 2+ dp bilat, left arm bleed/dressing over av graft pertinent results: 07:30pm glucose-99 urea n-94* creat-10.9*# sodium-138 potassium-8.0* chloride-99 total co2-24 anion gap-23* 07:30pm wbc-7.6 rbc-3.67* hgb-12.5* hct-38.9* mcv-106* mch-34.1* mchc-32.2 rdw-16.2* 07:30pm calcium-10.0 phosphate-3.4 magnesium-2.8* 07:30pm neuts-67.0 lymphs-21.3 monos-7.5 eos-2.7 basos-1.4 07:30pm pt-23.6* ptt-39.2* inr(pt)-2.4* 07:30pm ck-mb-7 ctropnt-0.21* 07:30pm ck(cpk)-79 07:42pm k+-8.1* 11:27pm potassium-6.6* brief hospital course: #) left arm av graft failure: pt presented w/clot of left arm av graft and access for emergent hd right femoral access was obtained and emplyed for hd. pt was then taken to the ir suite and thrombectomy of the left av graft was attempted w/o success. a venogram of the region was also obtained. post intervention the pt experienced a bleed of the left arm access site which was monitored by ir overnight, pressure was applied though slow leaking bleed persisted overnight the day of procedure. at the time of procedure inr was 2.5 and coumadin was held and on post intervention day one had decreased to 2.1 and the bleed stopped. based on the failed thrombectomy renal transplant surgery was consulted for long term access for hd. pt was planned for left proximal av fistula w/permcath placement in the interim. pt underwent repeat venogram of more proximal vessels in preparation for surgery. pt was planned for routine hd via femoral cath. the day of ir intervention, overnight the femoral cath was associated w/proximal tenderness and local bleed externally which resolved w/pressure and occlusive dressing, no signs/symptoms of significant internal bleeding were noted. on the day prior to discharge, the patient had a new av fistula placed on his proximal lue. he also had a permacath placed on the left side (ij). the patient was dialyzed through the permacath on the day of discharge without incident. he developed slight oozing from his new graft site after dialysis, thought to be related to heparin given during hd. he was discharged with dressings and instruction to return with any symptoms, such as lightheadedness, cp. . #) anemia: hct as low as 26.4 though pt asymptomatic: w/o orthostatic signs, lightheadedness, no feelings of fatigue, aox3. drop in hct from 30 is likely bleed over the previous 24-48hrs following ir access. at that time rbc was noted to have dropped w/o drop in hct. i suspect the hct did not change at that time due to the acute nature of the bleed and at this time his fluids have re-equilibrated and now the hct reflects the blood loss as well as the rbc. the patient received 1u prbc prior to graft surgery and permacath placement. . #) hyperkalemia: pt was noted on admission to have hyperkalemia w/potassium of 8.1. renal was consulted and pt received calcium gluconate, bicarbonate and insulin and then sent for emergent hemodialysis. post hd potassium was noted to be 5.6. on the second day of admission potassium was again elevated to 6.2 and patient was taken to hemodialysis. it was determined to repeat hd as this also would coincide w/regularly scheduled hd regimen and avoid side effects of kayexolate. it was also decided to discontinue acei as it was considered to be contributing to hyperkalemia. . #) cardiovascular: pmhx significant for cad, chf and hyperlipidemia. on presentation pt w/o sob, cp, dyspnea, syncope. on transfer from the micu to the medicine floor exam revealed bp 90s/40 pt reported baseline low pressures of 100s systolic. pressures low likely secondary to hd w/1kg taken off. pt w/o orthostatic signs and was asymptomatic. over the next 24hrs pressures corrected and had increased to 110s/70s without intervention. . #) esrd: pt w/hx of renal ca and left nephrectomy. esrd w/hd dependency. hd per hd team was maintained via femoral access until alternative permanent access placed by the renal transplant team. the patient left the hospital with a graft in his l arm, a permacath on the l (ij). the r fem line was discontinued. . #) atrial fibrillation: pt w/hx of afib and maintained on coumadin 3mg qhs as oupt. the patient's coumadin was temporarily held prior to surgery for graft placement. the patient was discharged back on coumadin 3mg qhs. medications on admission: #. atenolol 50 mg tablet sig: one (1) tablet po daily #. pravastatin 10 mg tablet sig: one (1) tablet po daily #. aspirin 81 mg tablet, chewable sig: one (1) tablet po daily #. pyridoxine 50 mg tablet sig: two (2) tablet po bid #. cyanocobalamin 100 mcg tablet sig: one (1) tablet po daily #. folic acid 1 mg tablet sig: one (1) tablet po daily #. b-complex with vitamin c tablet sig: one (1) tablet po daily #. cinacalcet 30 mg tablet sig: one (1) tablet po daily #. calcium acetate 667 mg capsule sig: one (1) capsule po with breakfast and lunch #. calcium acetate 667 mg capsule sig: two (2) capsule po with dinner #. warfarin 3 mg tablet sig: one (1) tablet po hs (at bedtime). #. captopril 12.5 mg tablet sig: 0.5 tablet po every other day. #. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation every four (4) hours as needed for shortness of breath or wheezing. #. digoxin 50 mcg/ml solution sig: one (1) ml po every other day. #. colchicine prn gout flair discharge medications: #. atenolol 50 mg tablet sig: one (1) tablet po daily #. pravastatin 10 mg tablet sig: one (1) tablet po daily #. aspirin 81 mg tablet, chewable sig: one (1) tablet po daily #. pyridoxine 50 mg tablet sig: two (2) tablet po bid #. cyanocobalamin 100 mcg tablet sig: one (1) tablet po daily #. folic acid 1 mg tablet sig: one (1) tablet po daily #. b-complex with vitamin c tablet sig: one (1) tablet po daily #. cinacalcet 30 mg tablet sig: one (1) tablet po daily #. calcium acetate 667 mg capsule sig: one (1) capsule po with breakfast and lunch #. calcium acetate 667 mg capsule sig: two (2) capsule po with dinner #. warfarin 3 mg tablet sig: one (1) tablet po hs (at bedtime). #. captopril 12.5 mg tablet sig: 0.5 tablet po every other day. #. albuterol 90 mcg/actuation aerosol sig: 1-2 puffs inhalation every four (4) hours as needed for shortness of breath or wheezing. #. digoxin 50 mcg/ml solution sig: one (1) ml po every other day. #. colchicine prn gout flair discharge disposition: home discharge diagnosis: primary: 1) left av shunt stenosis 2) hyperkalemia secondary: 1) esrd 2) chf 3) cad discharge condition: improved, vss, afebrile discharge instructions: take all medications as prescribed. attend all of your outpatient dialysis appointments. schedule a follow-up appointment with your primary care physician, . at . followup instructions: schedule a follow-up appointment with your primary care physician, . at . . provider: , md phone: date/time: 10:30 md procedure: other revision of vascular procedure hemodialysis venous catheterization for renal dialysis transfusion of packed cells revision of arteriovenous shunt for renal dialysis diagnoses: anemia in chronic kidney disease end stage renal disease mitral valve disorders congestive heart failure, unspecified acute posthemorrhagic anemia hyposmolality and/or hyponatremia gout, unspecified atrial fibrillation aortocoronary bypass status hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage v or end stage renal disease other and unspecified hyperlipidemia hemorrhage complicating a procedure surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation personal history of malignant neoplasm of kidney diseases of tricuspid valve other complications due to renal dialysis device, implant, and graft chronic diastolic heart failure 

Answer: The patient is high likely exposed to