Category Archives: End of Life Issues

I am medical POA for a friend who lives alone and is in end-stage renal failure. She refuses to allow me to call for hospice, and has become verbally abusive and uncooperative to those who look in on her. She cannot make it to the bathroom on time, and has had diarrhea and vomiting episodes, yet refuses to allow us to change sheets or help clean up in any way — yelling, screaming, etc. I called her doc to ask if he could prescribe anything to help calm her down — he said no, that she needs hospice. I’ve contacted hospice, and they are willing to come at any time, but without her consent, our hands are tied — and she will not give it. She has regained some appetite after going nearly two weeks of not eating much, but she vomits and has diarrhea, and complains of constant ringing in her ears. She is pitching fits because the bank changed her debit card to one that no longer has raised letters on it — irrational hate and anger. She is conveniently blind due to diabetic retinopathy, but can see what she wants to see. Can you provide any advice for how to proceed? I am at my wits’ end. Thank you.

This is a very difficult situation.  The observations that you describe sound like your friend is experiencing either delirium or dementia.  You may need to consult with a psychologist or a psychiatrist and see whether your friend in competent to … Continue reading

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

My mother aged 79 years. She is diagnosed as CKD, Creatinine 4.5, blood urea 160, minimum urine output, swollen face and stomach, breathlessness, a case of heart failure. A case of renal stenosis, 3 stents were put related to heart, 2 stents were put to renal arteries one year back. Doctor says she can not withstand dialysis. Dietar 10 mg was administered for last one year. Not much benefit in the last 2 months. Lasix 40 mg is being given now in addition other medications. Renhold, Q180 etc. Please advise.

I am not able to establish a specific diagnosis based on the information that you present.  Your mother obviously has very advanced kidney disease.  If there are no further treatments available to her, and she cannot survive dialysis treatments, then … Continue reading

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

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