My mother, 62, a diabetic for the past 10 years, 6 years on insulin, suffered hypoglycemia three weeks back. Her creatinine started to spike with potassium, going up to 5.1 and potassium to 6.5. After two days of fluids in a hospital, her creatinine levels dropped to 4.8 and potassium under normal range 4.5. Doctors were advising dialysis, three times a week, life long, but after talking to the head of nephrology, they said she is responding well to medicines and tests, but sugar levels are fluctuating 100-300. However, when I talked to other doctors at another center, they said they don’t advise dialysis for patients with constant creatinine under 5, and suggest decreasing it by food control, diet and medication. Is dialysis needed at all? If creatinine keeps on dropping slowly, even then is dialysis required? If dialysis is needed, then it will be periodical, let’s say monthly or twice a month, once in two months OR thrice weekly/lifelong? Is kidney replacement an option if she has diabetes?

I am not able to provide medical advice without performing a complete history and physical examination. As I approach problems like this, I encourage families to carefully listen carefully to their parents and older individuals for their preferences. The decision to undertake or forego dialysis therapy is a very complex one and needs to be carefully discussed with her doctors and her primary care physician. These decisions are never easy, but if you listen carefully, your mother will give you the answer. Dialysis is not started because of a specific number for the serum creatinine or because of a specific symptom. It is recommended by physicians who are familiar with dialysis therapy and agreed to by patients who believe the risks and complications of dialysis are worth the cost, discomfort and inconvenience that may arise from dialysis therapy. Patients with diabetes may do just fine with dialysis, but do not survive as long on dialysis as non-diabetics.

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