Nephrologist (Kidney Specialist) Questions Dialysis

Can a person with just 20% kidney function survive without a dialysis?

My mother in law is 75 years old. According to the doctors her kidney function is only about 20% and they have been suggesting that she should undergo a dialysis. However, due to the age factor she is reluctant to start with the same. What are her chances of survival without dialysis?

9 Answers

In general, there is not need to start dialysis at 20% of kidney function. However, at 20% of kidney function, she is at high risk for further deterioration of renal function even when the other risk factors are controlled.
When she gets to 10% renal function, she will need dialysis!
Yes, with kidney function 20 pt don't need dialysis. Mostly, dialysis is needed when function less than 10.
Other than eGFR (function), sysmptms of kidney failure also play a role to decide when dialysis needed. Plz talk to a nephrologist.
A patient can survive with 20% kidney function if the kidney function is stable (no further decline) and if the patient is receiving supportive care to keep complications of kidney dysfunction compensated.

Most patients continue to decline and require dialysis for survival. A patient needs to be prepared to do dialysis when the time comes and preparation takes time. Prepared patients do better in terms of quality of life and survival; that is the reason to discuss and prepare for dialysis

Adriana Cano.
Based on kidney function alone, she can be monitored closely. Generally, we start dialysis once the function is at 15% in diabetic patients and 10% in non-diabetic. Patients will eventually die from kidney failure.
Dialysis is not indicated and should not be needed at 20% kidney function. Focus should be to stabilize her kidney function. At this level of kidney function she should do fine with appropriate medical management.
There are several aspects to this question.

Usually, dialysis may not be needed at a GFR of 20, but that is the time an access is planned to ensure that patient can start dialysis in future. Some patients with issues with volume management or persistent hyperkalemia may need to start dialysis at GFR more than 15, but not too many. If she has multiple comorbidities and does not want to do dialysis, then there are options for medical management with dietary modification and supplemental medications. It is difficult to say what the long term prognosis or duration of life may be for each individual patient without actually evaluating them. Data shows that elderly, debilitated patients with multiple comorbidities may not do as well on dialysis as those without these risk factors. Please feel free to come for a second opinion, if you would like to.
Most of the time, yes.
All depends on her comorbid conditions and also the rate of decline in renal function. If she does not have much medical problems and her decline in renal fn is a slow process, she still can wait .No hurry for any dialysis now. Usually, pt with heart failure, edema(swelling), diabetes etc. may end up on dialysis sooner than pt without the above problems. If she is ok without other comorbid conditions, she will do ok for a while. Hope this will help you. If further questions/concerns, pls contact. Thanks.