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.

DEAR DR. ROACH: Are there health benefits that are associated with liver support products, which are found in a variety of options that are sold over the counter? I am a 60-year-old man who is in generally good health and imbibes occasionally (four to five drinks per week). — C.C.

ANSWER: A very good rule of thumb is that your liver doesn’t need any kind of supplementation to keep it working well. It has remarkable self-regenerating abilities, but even these abilities can be overwhelmed when taking in substances that are harmful to the liver.

Alcohol is probably the most common liver toxin in North America, although four to five drinks per week is not usually enough to cause liver damage (unless you are drinking them all on the same day). To keep your liver from being damaged, definitely keep your intake to below two drinks per day. (This is the guideline for men; the guideline for women is one drink per day.)

Ironically, supplements have been a fairly frequent cause of liver damage. Turmeric, green tea extract, echinacea, goldenseal, black cohosh, red yeast rice, and vitamin A can all cause liver damage, especially when taken in higher-than-recommended doses.

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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. (c) 2026 North America Syndicate Inc.

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