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Hello everyone,


my father (91, heart failure stage 2, kidney failure stage 4) just got his recent blood work. I expected his GFR to decline further but it has dropped from (30 in 10/2019 -->29 in 01/2020 --> 24 in /05/2020). I feel so paralyzed by fear. In 2018 his GFR was at 44. The last couple of days he had issues with diarrhea and today is the first day he is feeling better again. I'm just at a loss. He has no symptoms like ankle swelling. We try to get him to drink more but it's not that easy. I'm all over the place at the moment. I don't even know what a GFR of 24 means, I know it's kindey stage 4 but what am I looking at in the future?


Thank you :)

Hanna, I think what you (and father) are looking at may be no good options. I just want to encourage you to try to come to peace with the fact that 91 is a "ripe old age" and that no one lives forever...but thinking our LO may suffer IS devastating. You have every right to feel this way. My 85-yr old MIL just "recovered" from covid. It seems she will not go back to being her prior self, which is not saying much. Now her cognition is worsened and she doesn't want to eat and barely drinks and the NH can't force her. She is still not off oxygen. The thought of her (probably) slowly fading from malnourishment is unthinkable, especially since we can't even visit her. She can barely carry on a brief phone conversation. Putting your father through further treatments may not improve him much, and may distract from having quality time together with him, whatever time he has left. If he can be made comfortable that may be the best thing for him, even if it doesn't feel that way for you and your family. I sincerely wish you peace in your heart as you journey on this path with him.
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Hanna123 Jun 5, 2020
Thank you for your reply Geaton777, I'm so sorry to hear about your MIL. I hope things will improve for you and your family. My dad is in no condition to undergo treatments like dialysis. Not in a million years would I put him through that. We just focus on keeping him comfortable. And he is at the moment. He mostly sleeps, which is very hard to see as he was a very active person. He worked way into his 80's. I'm just grateful for the things we have. It could be worse.
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"If your estimated glomerular filtration rate (eGFR) is 24 milliliters per minute per 1.73 meters squared and if it has been present for at least three months, then you have Stage 4 (out of 5) chronic kidney disease (CKD) and should be followed by a nephrologist."

From what you wrote, you already know he is in stage 4.

"Water ingestion can acutely affect GFR, although not necessarily in the direction one might expect. Using 12 young, healthy individuals as their own controls, Anastasio et al. found increased water intake actually decreases GFR."

From the above, it looks like drinking more water doesn't really help.

Your Dad is 91. His body is wearing out. I think you just need to enjoy the time you have together. Be glad you have had him this long. Not everyone is so lucky.
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Hanna123 Jun 5, 2020
Hello JoAnn29, thank you for your reply. I didn't even know that drinking water could decrease GFR. You are right and I always try to comfort myself with that. My dad is lucky to be at that age and especially to have my mum take care of him.
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With your dad having both heart and kidney issues, you may want to try palliative care for him. This is not hospice care and there is no 6 month rule for care as there is with hospice. Palliative would provide a care team whose focus is comfort but still maintain his current medical protocol. However, palliative care is usually provided by a hospice agency.
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Hanna123 Jun 5, 2020
Hello sjplegacy, thank you for your reply and suggestion. I will look into that. We want to keep my dad at home (as long as he is comfortable and safe here).
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The GFR will need to go under 15 for dialysis. My mom is 97 and her stage 4 is into year 3. She will not go for dialysis when the time comes. She has a decline to 20. She tends to sleep more and she has a poor appetite with some weight loss. She still pees a lot so no swelling. It is just that her blood holds more of the toxins. You can reach out to a nephrologist to determine if one of his other meds can be adjusted to slow it down.
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Hanna123 Jun 5, 2020
Thank you for your reply MACinCT. Did your mum have a slow of fast decline of GFR before she got to stage 3, if I may ask? My dad pees a lot too. I had a talk with his doctor and he said that we should wait a bit. My dad had diarrhea for a couple of days, so that might had an impact on the lab results. At the moment he doesn't sees the need to change his medication.
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What is his creatinine? Reviewing his labs there is a decline but he can stay at CKD 4 for awhile. They usually start thinking about starting dialysis with a GFR less than 15. So you have a way to go.
I am not sure I would begin dialysis on a 90 year old unless he was Jack LaLaine. Hemodialysis is grueling on a body yet alone a 90 y/o.
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Lain129 Jun 4, 2020
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The dyes used in testing like an angiogram, cardiac cath or any test using contrast dye.
They definitely don’t begin dialysis for a Creatinine of 2 or 3 or even 4! Everyone is different, remember.
You have a way to go.
Continue what you are doing & visit those 2 websites for the CKD diet.
But also, realistically, he is 91,and if he enjoys eating foods he isn’t supposed to I would allow him that.
Unless something stresses out his kidneys now to tip him into CKD 5 I would hypothesize he won’t die from renal failure. At his age he is fragile and many things could happen, so take what I say as a non expert but an old RN.
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Hanna123 Jun 6, 2020
Thank you for the clarification. My dad gets whatever he asks for but he really likes the nutrition drink. So we got really lucky with that :).
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Hello Shane1124,

thank you for your reply. After his lab results from january I was hoping that the decline was slowing down. His creatinine is 2,26 mg/dl. Dialysis is totally out of the question.
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Shane1124 Jun 5, 2020
He won’t need to start dialysis with that Creatinine. Keep on what you’re doing because you are keeping him off dialysis with your care regimen.
You just need to maintain where he is at. He also could have been dehydrated which would increase the creatinine level but it sounds like he is CKD 3 as well as been in renal insufficiency for quite some time on review of the labs you provided.
No IV dyes for him if they ever want to do any such test.
You can find the CKD diet and loads of information for you at the National Kidney Foundation website or NIDDK.gov.
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My mom has a slow decline. One other thought is if he is not fully emptying and retaining urine in the bladder, it can back up to the kidneys and cause rapid decline. I think this is rarer
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Hanna123 Jun 6, 2020
Thank you for sharing. My dad pretty much as much as he drinks. I guess with the condition you describe an UTI or kidney infection go hand in hand with that. I hope it doesn't come to that.
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