My step-dad has CKD and his GFR is 16 and he is insulin dependent with diabetes and is 70 yrs old. He has already had kidney transplant a couple of years ago. In addition, he has problems with his legs. When he walks very often he has pain in his legs. Surgery was going to be done on his leg, I believe its called angioplasty, not sure. But, after careful thought he changed his mind of getting it done. My dad does not walk much because of the pain although he has his days and he will walk a little. But, for the most part he just walks usually around the house if he needs to go to a particular room. If he walks outside he uses a walker because his stability is not great all the time especially when he does not walk much in the week. The issue he has been having despite the walking issue is that he does not have much of an appetite and does not want to get up in the AM. He has problems sleeping at night. But despite that he just doesn’t want to get up from the bed. Therefore, he is unable to check his sugar nor blood pressure as he is supposed to. He also must take his meds once a day and due to him getting up in the late afternoon that is when he decides to take it and eat a little if need be. But, again not much of an appetite. He does drink sometimes the shake that is geared good for the kidney/diabetic person. But, when he does that he abuses it because then he will drink it with some food. As opposed to just drinking the supplement. My question is the following: a. If his GFR is 16 why did his doctor not put him on dialysis right away? b. Why does he not want to get up nor eat much if at all and stay in bed? c. Should he be taking his meds so late like after 2pm? d. Also, he was told to use a mask that is attached to a small machine for when he sleeps not sure if its for oxygen at night and it is set at a certain rate. But , he doesn’t use it because he claims he feels he doesn’t need it. d. Lastly, what could be wrong? Do you think it’s just depression? My mom lives with him alone and does not know what to do. I don’t know also what to tell her. Can you help me with these questions I have?

Dialysis is not started based on a single number or test.  Dialysis is started when the patient and his nephrologist think that there could be a benefit of dialysis and the risks are understood and agreed to.  The questions that you ask are very good and need to be asked of the nephrologist and physician who are treating him.  I am unable to make any specific diagnosis based not the information that you present.  I also cannot recommend treatments without performing a complete history and physical examination.  I would be concerned about the possibility of dementia, delerium or other causes of your step-father’s reluctance to follow medical advice and non-adherence to his medical treatments.

I suggest that you write these question down and ask his physician and his nephrologist to discuss this with you and your mother.  Your step-father may also need further examination and consultation.


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