Looking for info - rapidly decreasing EGFR

I am my 73 year old Mother’s caregiver. She lives independently but is highly dependent upon me. I go with her to all of her doctor appointments, and any where else she needs to go. She is currently stage 4 kidney failure and I’m just trying to wrap my head around things because I can’t ask her doctor all of the questions I have because she will shut me down.

About a year ago, her EGFR was 44. Last month, it was 22, down from 31 in January. The rapid decline in that time changed the tone of our conversation with the doctor. We repeated blood work, went for an ultrasound and we’re back in to see him within a week. We are due to go back in about a week and a half after more blood work.

Her overall health isn’t great. On top of a lot of other things, she had a stroke last fall and has significant vascular disease.

He flat out told her she will not be a candidate for a transplant. We had some pretty candid conversations about advanced directives and he said that he would recommend delaying dialysis for her until it was absolutely necessary.

My stepdad was on dialysis for 7 years before he passed. I forget what it was called, but he did it at home daily. He started his when he was healthier than she is now, and I think for him, dialysis prolonged his life and sustained his quality of life. For my mom, I think it would prolong her life, but I’m not sure it would sustain her quality of life because I think the frequent trips to the dialysis center will exhaust her. There were some other things the doctor said that I interpret as he expects this to progress quickly. Instead of our normal, “we’ll see you in three months,” it’s become, “I need to see you in a month’s time.”

This week, she has started complaining of swelling in her feet (new), an inability to sleep and yesterday was vomiting. Ideally I’d get her back to the doctor, but she won’t go. The only way she’s going anywhere before the next appointment is if she has an emergency and is taken by ambulance.

I guess I’m just wondering how fast this might progress. I know there isn’t a simple answer and I’ve flat out told her I am extremely worried about her.

I appreciate any experience or thoughts. I don’t expect anything great, I just can’t temper my anxiety. Every time she has a symptom, I have to wonder if it’s because of the kidneys or something else.

Also, for what it’s worth, she only has one kidney that is really functional at this stage. When her an aortic aneurism repaired two years ago and the doctor told her then it was so far gone that they weren’t going to try to save it when they put the stent on the aneurism.