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Friday, April 18, 2014
My father told me that his kidneys are functioning lower than 10%. He is 82 years old, on high blood presure med. cholesteral meds and has had type 1 diabetes for 10 years or so that we know of. Could he have some other problem that is causing his kidneys to function poorly? I am afraid that an HMO plan is not going to take good care of him. I am not financially well off enough to call in the top doctors. He doesn`t want to go through dialysis. What do you think?
The cause of your father's advanced kidney failure is almost certainly a combination of diabetes, hypertension, and atherosclerosis (hardening of the arteries), which are the most common causes of kidney failure in this country. Either his primary care doctor and or an HMO-approved kidney doctor should be able to accomplish the basic things that may extend your dad's life as long as possible, such as controlling his blood pressure, blood sugar, and cholesterol, and getting him to stop smoking, if he smokes.
At his low levels of kidney function, it is hard to know what will happen. He may get along OK for weeks, months, or even a couple of years. But if his kidney function declines further to the point where he definitely needs dialysis and he chooses not to go with it, he needs to be aware that he probably cannot live for more than a few weeks. The decision not to accept dialysis should be made in a well-informed manner and (if possible) only after extensive discussion with one's family. It is hoped that everyone will be in agreement and will feel comfortable with whatever decision he makes.
If he is a US citizen, be aware that dialysis is paid for by Medicare.
Perhaps a good starting place would be for him to talk with his primary care doctor and/or visit a dialysis unit to see if his objections are realistic ones. He may feel differently if he knows more about the actual process of dialysis and the lifestyle of dialysis patients. In the meantime, please encourage him to take his meds faithfully and to stick to dietary restrictions, in order to extend his kidney life as long as possible.
Mildred Lam, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University