Age 82 and eGFR of 9 - options?

Do doctors know why it dropped so much in one year? Is she hydrating?

I hope she can get a Cystatin C version of the eGFR which may be better. So many things affect the creatinine. Hydration, muscle loss, eating cooked meat, low blood pressure, low heart function etc. etc.

If it is clear she needs dialysis, I hope someone comes on with experience, but first I would wonder if that creatinine drop is real, and also why it dropped.

We’ve been to two kidney specialists and neither can provided an explanation on why it dropped. She does have type 2 diabetes for over forty years but it has been well managed. Currently she’s not even on meds for diabetes. Since she has had chemo to treat her CNS Lymphoma in past years. Her radiation treatment was targeted to just her brain tumor so that cannot be a cause? She also had a couple of UTIs in past years.

I believe she is hydrating decently but that was the initial thought that she may be dehydrated.
She takes meds over four time slots. Each time with a glass of water. Then water with lunch and dinner.

We have found that due to her age and cancer diagnosis doctors think there may be limited quality of life. When her CNS Lymphoma came back in 2020 after being in remission for almost 3 years her original oncologist suggested hospice and gave her 3-6months. We found a great oncologist at MSK who has helped her fight it twice now. Now if only we can find her a kidney doctor willing to fight with her?!

My GFR was 8 when I was told to go to ER. Being admitted to hospital seems to be the fastest way to get a nephrologist but i agree that getting appointments is hard.
Hope your mom can get some help. Could be the placing of a fistula they concerned about rather than the dialysis. I think it’s pretty serious surgery.

She wouldn’t be able to have a line in her arm since she had IV infiltration a couple of years in one arm causing her other arm to be over used for blood draws. She would need a line elsewhere for center dialysis or home dialysis.
She actually was hospitalized for high potassium in April and got discharged after stabilizing her potassium without ever seeing a nephrologist at the hospital. ☹️

My mother had major GI surgery at 93. Doctors offered hospice and I spent two days deciding (I had an invoked proxy due to her dementia). She wanted to live so I okayed the surgery and she had another 3 years.

Quality of life is very individual. My mother was in bed the last year and whenever I came in the room she would talk about how beautiful the blue sky was. I believe she had quality of life when another person might not see it that way.

Medical professionals see an older person with complicated issues and they are right to think about not prolonging suffering but only the person and family can know the right way to go.

I am surprised no nephrologist was involved. Did the eGFR go up with IV hydration?

When she was hospitalized for high potassium she didn’t receive much iv hydration due to her poor veins in her left arm. ER causes IV infiltration in the arm - nurses noticed when she got moved into a patient room. They can’t use her right arm due to IV infiltration that required surgery a couple of years ago. So I’m not sure on whether IV hydration will improve her eGFR. My mom doesn’t have any dementia- she is still very sharp. She is wheelchair bound, however she still goes out for walks on nice days. She isn’t ready to say goodbye. She’s willing to try. She has eight grandkids she loves spending time with.

@ckdcaregiver I have been reading your posts and the helpful comments/responses by several fellow members.

First, welcome to Mayo Clinic Connect. I am glad you feel comfortable sharing the dilemma your mother is facing.

If this was my situation, I would ask for a "team meeting". That is, your mother, her doctors and specialists, and you all together to discuss the best options. She has particular circumstances, being chair-bound, with additional health concerns. Making sure her team understands her preferences, and listening to their feedback, may go a long way to making decisions for her care. I am so surprised to hear she does not have a nephrologist on board. Being realistic and understanding the nuts-and-bolts of the situation is critical, in my opinion. Without some type of immediate intervention, if her kidneys continue to fail, her life expectancy becomes short. Her organs will begin to be compromised past a point where they can be stabilized. It is my thought that time is of the essence.
Ginger

Hi Ginger. Sorry if this is a dumb question. How do I go about getting a team meeting? Her oncologist is with MSK while her kidney specialist that we have seen only twice is with Cornell. She was hospitalized with high potassium at NYU and have seen a specialist there once a few weeks ago. I’m so confused and scared. I want to ensure she has the best opportunity to extend her time BUT I don’t know how to best help her. I feel as if I’m going in circles - hamster in a ball. This is the first time I’ve reached out in a support group - I’m so lost. Thank You.