Dear Dr. Roach: A loved one of mine has had kidney problems for his whole life. He’s now on the transplant list, and his kidney function is very low. But he continues to avoid dialysis, saying that he’s not ready for it. Surprisingly, his heart health, cholesterol and blood pressure are always great when tested. He sometimes has swelling if he’s on his feet for too long, but this can be reduced by going on medication for a few days.

He also has uncontrolled diabetes. At one point, his A1C level was over 11%, but now it is closer to 6% or 7%. In addition, he’s on a biologic due to an autoimmune disease. How long can someone with a glomerular filtration rate (GFR) that is lower than 10 be expected to function without starting dialysis or getting a transplant? How long can someone like him survive if he continues to avoid dialysis? — Anon.

Answer: The answer is one to two years for a person with a GFR of 10 who doesn’t receive kidney replacement therapy, like dialysis or a transplant. Some people will do well for even longer periods.

I have had more than a few patients who were in similar situations, some of whom had decided against dialysis, while others, like your loved one, were undecided. But the vast majority decided to take dialysis once they started feeling more unwell. As their kidney disease progresses, their ability to get rid of excess fluid, even with medication, decreases. They are also likely to have symptoms such as a loss of appetite, nausea, and “brain fog.”

People with progressive kidney failure may suffer from medical emergencies such as critically high potassium levels or severe levels of acid in the blood, which usually require emergent dialysis. Eventually, medications will only provide temporary relief. Your loved one should be prepared to answer what they would do if this happens.

You may wonder why his diabetes is controlled when it wasn’t before. One reason is that insulin lasts longer in the body when the kidneys aren’t working well. He might also not be eating as much.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.