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HomeAnswersNephrologychronic kidney diseaseI have chronic kidney disease. Do I need dialysis shortly?

Is dialysis required for a renal failure patient with a GFR of 13?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. Sneha Kannan

Published At December 5, 2021
Reviewed AtOctober 11, 2023

Patient's Query

Hello doctor,

I am a 43-year-old male. I often feel tired, confused, and nauseous. I have back pain, headaches, and indigestion often.I am feeling sick from PKD. I am suffering from renal failure with GFR of 13. I am currently not under any medication. I need an ESRD diagnosis.

Kindly help. Attaching the relevant reports.

Hello,

Welcome to icliniq.com.

I have gone through your reports (attachments removed to protect patient's identity).

The reports suggest chronic kidney disease (CKD) stage five due to polycystic kidney disease (PKD). The stage of CKD is such that you need to prepare for renal replacement therapy. For this, you have to be put your name on the transplant list, and fistula is to be made (if not already made). I would suggest you get the fistula made. Kindly share the latest CBC (complete blood count) report too.

Patient's Query

Hello doctor,

Thank you for the reply.

Kindly let me know that whether I will need dialysis.

Thanks.

Hello,

Welcome back to icliniq.com.

Yes, you need to prepare for dialysis by making a fistula. Even though urgent dialysis is not required, you need to be ready for dialysis in the long term. You have metabolic acidosis and probably anemia, which needs to be treated. If you are symptomatic, then you need to start dialysis immediately.

Hope you find the reply useful.

Regards.

Patient's Query

Hi doctor,

Thank you for the reply.

I understand. Thank you so much for your assessment. I cannot thank you enough.

Hi,

Welcome back to icliniq.com.

I have received your query. You are saying you have persistent symptoms. I guess you need to see your nephrologist first before starting dialysis immediately. Also, you need to repeat one kidney function test. Also, you need to get a fistula made for dialysis. Regarding disability, I do not think you can be denied the same. You should get qualify for disability, as per the expert witness.

Patient's Query

Hi doctor,

Thank you for your answer.

I appreciate all the help you have given me and will always remember and appreciate you. I have decided to let myself die rather than seek treatment because I do not trust kidney treatments and psychologically cannot proceed with them. My father died from PKD after mistakes made during and after a transplant many years ago, which left me traumatized. Also, I cannot afford treatment. Consequently, do you agree that I would be disabled (itching, nausea, weight loss, headaches, back pain, weakness, tiredness, confusion, and memory problems) and am dying from stage five kidney disease (ESRD)?

Thank you again, doctor.

Hello,

Welcome back to icliniq.com.

I would be glad if I could help you. Choosing treatment or not will always depend upon you. Treatment of ESRD (end-stage kidney disease) will depend upon the symptoms and level of azotemia (glomerular filtration rate and serum creatinine). If you do not choose dialysis or transplant (when needed), you can still be given medications to help with itching, nausea, and tiredness. If you do not choose treatment, you can be disabled. But, with treatment, especially transplant, you can almost live life normally. So it always depends upon you what treatment you want, but I will suggest you choose treatment like dialysis or transplant if you can afford it.

Patient's Query

Hi doctor,

Thank you for the reply.

After a couple of years of consideration, I have concluded that under any circumstances avail myself of dialysis, which is, in my opinion, barbaric and only for those who fear death more than they fear a risk-plagued, anxiety-filled existence and terrible quality of life. The fistula alone is both traumatizing and almost barbaric and inhumane to me. My father agreed with this assessment of dialysis. I inherited my PKD from him. He died following transplant because he was given a damaged cadaver kidney. The transplant medication severely suppressed his immune system and led to infection, sepsis, cancer, and death. The only transplant I can receive is from a nonrelated donor that requires substantial immunosuppression that will harm me as badly as it harmed my father. Getting a transplant for me would be like trading kidney failure for diabetes and AIDS since the transplant medication destroys your immune system and causes diabetes. I was a nurse assistant in a renal transplant unit, so I know what I am talking about. Dialysis does not always extend life that far either. I have watched my patients (young patients) die following dialysis and transplant. I likely was just diagnosed with post-traumatic stress disorder (PTSD) subsequent to a psychiatric appointment today. This mental illness is partly due to my exposure to kidney treatments that did not work, and it also prevents me from pursuing these treatments. I am managing my disease through diet the best I can. In light of the fact that I have stage five kidney failure ESRD, for which I will not pursue transplant or dialysis, what is my prognosis roughly? I know it depends on my overall health and the remaining level of function, but I read that I should expect to die within two months to two years. Also, do you acknowledge that many people on dialysis cannot work anyway? I have sent you articles showing that over 75 percent of people are not working as they start dialysis, and this number remains the same after dialysis. In other words, dialysis usually doe not enable people to work.

I cannot afford most nephrologists and consider you my nephrologist, and I respect you and appreciate the help you are providing to me.

Hi,

Welcome back to icliniq.com.

I understand your decision. Whether one chooses renal replacement therapy (dialysis or transplant) or not is always your decision. Now you are not opting for renal replacement; you can still be given treatment and live a long and comfortable life. The treatment would be low salt and low protein diet. This management includes the treatment of hypertension, bicarbonate therapy, and anemia. And hopefully, with this management, you will enjoy the good life.

Patient's Query

Hi doctor,

Thank you for the reply.

You are not able to give me a prognosis, though. The literature says someone who has ESRD once cannot live long without dialysis. Do you agree with that? Also, do you agree that dialysis often does not allow patients to work per the literature I provided? Please answer these questions, doctor, as I cannot afford to continue with your care after this follow-up question.

Hi,

Welcome back to icliniq.com.

Regarding prognosis, it is a difficult question. On average, if a patient needs dialysis and chooses it, he or she can live up to two years. This will happen if the patient takes medicines properly and has adequate dietary control. I would not agree fully with your question about dialysis often not allowing patients to work.

Dialysis is of two types: Hemodialysis and peritoneal dialysis. Hemodialysis is needed three times per week, so people need to adjust work to allow to go to the center for hemodialysis thrice a week. Thus conventional hemodialysis affects work. However, we can have home hemodialysis, where the patient gets dialysis at home at night. Thus the patient can go to work as usual. However, home hemodialysis is costly. Second, we have peritoneal dialysis. This is done by putting a catheter in the abdomen, and dialysis can be done at home or work. Thisallows one to work properly. PD (peritoneal dialysis) is done four times a day. It takes around 20 to 30 minutes to do one peritoneal dialysis exchange. Thus one can do perironeal dialysis at work also.

Thus while conventional HD (hemodialysis) can affect work, we have options that can allow people to work normally while being on dialysis.

I hope this will answer your questions.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Manzoor Ahmad Parry
Dr. Manzoor Ahmad Parry

Nephrology

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