Category Archives: End of Life Issues

My husband was recently diagnosed with kidney disease, caused by chronic heart failure. He has dilated cardiomyopathy (diagnosed 11 years ago) and has been taking amiodarone daily for 10 years. He has developed stage 2 diabetes, pulmonary problems, and has suffered with sleep apnea for over 20 years. He has survived colon cancer, but is being monitored for prostate cancer regularly. Within the last 4-6 months, the number of atrial fibrillation episodes he experiences daily has increased dramatically (20-30 per day) and he was recently told that his GFR “had dropped dramatically” from the prior test, which was 31. I’m not asking for a diagnosis, and realize you can only give me ball-park statistics, but I think we should be looking into end-of-life options and can’t get a straight answer from any of his doctors. We both think his body is beginning to shut down and I don’t want to get to the point that these decision have to made without time to think about them but, needless to say, my husband isn’t comfortable dealing with this decision. What advice can you give me?

The best person to discuss this is with your husband’s primary care physician (PCP). His PCP is able to interpret the information from your husband’s nephrologist, cardiologist, urologist, and oncologist. I suspect that you are correct. Dealing with this now … Continue reading

Posted in Ask the Doctor, End of Life Issues, Kidney-Related Health Questions

My 73 y/o father has been diagnosed with end stage kidney failure. His GFR is 12. He has a 4.5cm infrarenal aortic aneurysm but his doctor does not feel it is the cause. He has hypertension, CAD, atrial fibrillation, and a recent stroke. He has no specific symptoms that would indicate failing kidneys. He has made it clear he will not take dialysis. My question: how long can he expect to live?

I am unable to offer a prognosis without performing a complete history and physical examination.  This question would best be asked to a physician who can examine your father and know his complete medical history.  Your father may want to … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, End of Life Issues, GFR, Kidney Failure, Kidney-Related Health Questions, Symptoms and Side Effects, Treatments

Age 4 RT nephrectomy for blocked ureter caused kidney damage, no problems. Now age 61, coronary artery disease do 11/2018 many cardiac meds. 2017 GFR 70 pre cardiac meds. 10/2017 GFR 60, 11/2017 GFR 50, 2/2018 GFR 40, 3/2018, 50. Yesterday I asked my primary doctor if I should see nephrologist, he said no. I think I should investigate cause of decline with nephrologist. What do you think? His reasoning, they would just tell me to eat a low NA diet and keep BP down. What do you think?

There is a considerable variability to your estimated glomerular filtration rate (eGFR). This seems a bit unusual. You have a single kidney and one of your kidneys was removed as a child. Hence, your expected kidney function with a single … Continue reading

Posted in Ask the Doctor, Blood/Urine Testing For Kidney Disease, Diet/Nutrition, End of Life Issues, GFR, Kidney-Related Health Questions, Nephrectomy / One kidney, Nephrologist

My mother is 84 years old. She had dialysis for almost 4 years and had her last treatment on 12/22/17. She decided that she no longer wanted to have treatment. Her decision totally. The dialysis treatment was brutal and literally killing her. My question – she entered into home hospice the first of January 2018. As of today, she has not had dialysis for 80 days. She is also still producing urine – while not like she was before. She has always urinated more than anyone I ever known that was on dialysis. While I know she was probably not filtering the toxins out, she was still urinating a lot. She is confused – which is normal, very little intake of any kind. I know my mother is a strong woman. We are just so puzzled by the length of time since her last treatment. By no means do we want her to die, but from what we were told/reading, we thought she would go quick – like usual ESRD patients who stop dialysis. Thank you.

The length of time that one can go without dialysis is variable and dependent on the underlying state of health of the individual. For individuals who have been on dialysis for more than 6 months, such as your mother, the … Continue reading

Posted in Ask the Doctor, Dialysis, End of Life Issues, Kidney-Related Health Questions

My wife has been diagnosed with dead kidneys. She is 71 and told to have daily dialysis or die in 4 weeks . She is home waiting to die. Is there anything I can do?

Yes.  I suggest that you discuss this with your wife to learn why she does not want dialysis.  Your wife, if she is competent to make decisions, has every right to make the decision to not perform dialysis.  This is … Continue reading

Posted in Ask the Doctor, Dialysis, End of Life Issues, Kidney-Related Health Questions

My father is an 88 year-old man. He is diabetic, a colon cancer survivor, has a pacemaker, & had a valve replacement two years ago (5/2016). He is a retired attorney with sharp mental facilities; his physical activity is reduced as he now walks unassisted short distances. He lives in S. Florida with his girlfriend & was able to fly to me in over the summer to see  family including his grand kids. He has a lot to live for. At his last Dr.’s visit he was told his creatinine is 3.1, up from 2.6-2.8, 2-3 months ago, and that he is stage 4. When he asked his nephrologist about how long he felt he could have, he was told 1 – 1.5 years. He then asked if he went on dialysis, how long he may have. He was given the same time frame. Approx. 1 year ago, he shared with me that he would never go on dialysis. After visiting him last week, he spoke as though he was open to dialysis, however, certainly not if there was no hope of extending his time here. It was a very “crushing” conversation, as he looks great, said he feels great now, & had we been given a more optimistic time frame with dialysis, I feel he would be open. I want to help him research, yet ensure that whatever I can pass along to him will not create any type of false hope or optimism. My question is — where can I look to help support him, are there any other options (assuming a transplant is out of the question)?  How can I help keep him from falling into a state of depression?

I am unable to offer a prognosis without performing a complete history and physical examination.  It is true, that for the very elderly, the life expectancy with or without dialysis remains approximately the same.  If your father has no real … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Dialysis, End of Life Issues, Kidney-Related Health Questions

My father is 49 with ESRD, high blood pressure and diabetes. He also has a high urine output and very low amount of swelling. He decided to stop dyalisis 12/22/17. He has gone without for 18 days now. He doesn’t eat and he drinks about 32oz a day or less. He has very labored raspy and wet breathing. He is refusing all medications and going to the ER. We have tried over and over to contact hospice but they won’t come. My question is, is there any natural way to help with his breathing? Because everything else he doesn’t want.

The labored breathing is because of the kidney failure and likely related to fluid in the lungs. There is no other “natural” treatment for fluid in the lungs. Diuretics or dialysis would be required. His primary care physician (PCP) or … Continue reading

Posted in Ask the Doctor, Dialysis, End of Life Issues, Kidney Failure, Kidney-Related Health Questions, Nephrologist

My sweet husband is in stage 4 kidney disease and has just turned 80 yrs. He was dx with type I Diabetes almost 50 yrs. ago. He also has congestive heart failure, an unresolved pleural effusion, RA, chronic atrial fibrillation, and bronchitis. (he has never smoked). He has begun to suffer with kidney disease particularly with fatigue, de-conditioning, and dyspnea. I know it is difficult to predict his longevity, but can an experienced MD offer any thoughts for the remainder of his life? We need to plan for the future regarding his care needs, equipment etc. His memory is not bad, but abstract reasoning is more difficult. He is not a good candidate for Dialysis or transplant. Thank you.

In these situations, I find that the primary care physician (PCP) who has been caring for your husband, is the best person to contact about frank discussions such as the one that you are proposing. Prognosis and end-of-life discussions are … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, End of Life Issues, Kidney-Related Health Questions

Hello! Would you be able to provide information about some concerns I have for my cousin? She is 54 y.o. and sadly, it appears that her body may have started the end-of-life process. While I don’t know all the exact details, because she has a history of not telling the truth, this is what I know, about 6 yrs ago, she was diagnosed with very advanced of the more serious strain of PKD on both kidneys. Prior to that she went thru 2 open brain surgeries because of aneurysms, which no one said it was linked to PKD. She quickly deteriorated and was put on dialysis. She insisted on Peritoneal because she wanted to do it at home. From the beginning, she didn’t take her illness seriously and continued to eat her regular unhealthy diet, lying to everyone that it didn’t matter. I started to do research about PKD and by asking questions, figured out that it comes from my side of the family. Her mom (72) and her sister (60) both have cysts in their kidneys & liver, but both are in denial, although it has developed as bad as my sister’s. She has 4 adult children and I suggested to them a couple of years ago to get tested, because I read they have a 50/50 of having it. One of her daughters was just diagnosed, the others refuse. I had an ultrasound last year and was negative. My only surviving brother doesn’t want to know. But I digressed sorry. Her kidneys got so large and started getting infected, that she went thru a bilateral nephrectomy to make her feel better. Her doctors told her she had to make changes because she would get more sick, even with PD. She has never been compliant and she was taken off transplant list, which I totally understand because she wouldn’t take care of a new kidney, so doesn’t deserve it. In my opinion she doesn’t want to live any more, but may be afraid of accepting. She has had multiple hospitalizations in the past 24 months, doesn’t eat any more, very frail, no energy, feeling uncomfortable all the time. Last month she went thru parathyroid hyperplasia and thought she wouldn’t make it, but she did. Which brings me to my question, is now too late to even force her to have a transplant so she can live? As I type this, I realize I already know the answer. In your opinion, what can the family do? I’m assuming she doesn’t have much time left. Maybe I just need to mind my own business and let God do his thing! Apologies for my rambling, and thank you for your time.

One of the prime tenets of medical ethics is that a patient is autonomous to make decisions for themselves as long as they are competent. As long as your sister is competent to make decisions, all the decisions that she … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, End of Life Issues, Kidney-Related Health Questions, Polycystic Kidney Disease

I am puzzled. I have exhibited symptoms of CKD and those symptoms have remained consistent at 2.0 for about a year now. I am frightened that my CKD may decline in the near future and I am fearful of having, in that event, to drive from my home at Lake Chapala in Mexico to nearby Guadalajara (about one hour each way) for treatment and At 76 years of age, am unwilling to go through that although I am told that death would be the alternative. No one ever elaborates on the potential suffering and declines experienced by those electing to die rather than go through the torture (as I define it) of onerous treatment on a machine several times a week. Tell me, please, keeping in mind that I am in my mid-70s and come from a family where men rarely live to that age, if I refuse treatment, what may I anticipate in terms of declining health and ultimate demise if I refuse treatment. I do not fear your response.

I am not able to provide a prognosis without performing a complete history and physical examination.  You have the right to make decisions about participating in dialysis treatments or merely leading your life as long as you can and as … Continue reading

Posted in Ask the Doctor, Chronic Kidney Disease, Dialysis, End of Life Issues, GFR, Kidney Failure, Kidney-Related Health Questions, Medication and Kidney Function, Symptoms and Side Effects, Treatments