How can my mom’s kidney function be improved at 58?

Question

Hello doctor,

My 58 year old mother has stage 4 chronic kidney disease (CKD) with a glomerular filtration rate (GFR) of 22. The doctors were trying to prepare her for dialysis while managing her other health conditions. Her chronic kidney disease was caused by diabetes and high blood pressure over the past 15 years. Her creatinine has risen to 3.8, and she has proteinuria with 2+ protein on dipstick.

The nephrologist wants to place dialysis access soon, but she is terrified of this. Her hemoglobin dropped to 9.1, and she needs epoetin injections twice weekly, which are expensive. The phosphorus levels are high at 6.2 despite taking sevelamer with meals. She has also developed secondary hyperparathyroidism with parathyroid hormone (PTH) of 350. Her blood pressure is hard to control, even on four medications. Her osteoporosis has worsened with a T score of -3.1, and she already fractured her hip last year. The kidney dietitian restricted protein, phosphorus, and potassium, but she barely eats now. Please tell me,

What can we expect as CKD progresses?
Are there ways to slow kidney function decline?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Your mother has chronic kidney disease (CKD) with an estimated glomerular filtration rate (eGFR) of 22. This will probably require dialysis now or very soon in the near future. So it is better to create an access for dialysis right away rather than creating an arteriovenous (AV) fistula, because a fistula takes about six to eight weeks to mature before it can be cannulated.

Keeping an AV fistula ready will be helpful in the future if she has worsening renal function and develops volume overload or pulmonary edema. Meanwhile, if there is any emergency during these six to eight weeks (the time it takes for the fistula to mature), then a dialysis catheter can be placed to carry out the dialysis during this period & once the fistula matures, this catheter may be taken off.

Regarding quality of life, the majority of patients actually feel better with dialysis because the toxins & excess fluid overload are taken care of.

A hemoglobin of anything more than 8 is quite good for an advanced CKD patient, and 9.1 is a safe number. Epoetin (a synthetic form of the hormone erythropoietin) is standard, and it helps improve hemoglobin.

Blood pressure control is of utmost importance as uncontrolled hypertension can accelerate the decline in renal function. It is important to keep the systolic blood pressure under 140 millimeters of mercury.

High phosphorus & parathyroid hormone (PTH), and fractures are all due to mineral-bone disease secondary to CKD, and it requires combined nephrology and endocrinology care.

Her kidney function tests may continue to decline further, and dialysis usually becomes necessary when eGFR is as low as 15 or 10. To slow the progression, strict blood pressure and sugar control are mandatory.

I hope this information helps you.

Feel free to ask further queries.

Thank you.