It is not unusual for patients with advanced kidney disease (stage 4, for example) to be asymptomatic or for the symptoms to be so insidious that the patient doesn't notice them or denies them. That's why it's very useful for such patients to be seen with a significant other or relative who can prov...

Agree with all the points made by Drs. @Sam and @Wish. I often like to graph out their GFR for them, and talk about the journey of their kidney disease with discussion of "signs and symptoms" outside of just uremic symptoms. For example, I like to probe them on how their edema or blood pressure man...

First I tell them the exact kidney function. For example, your kidney function is 20% and I try to estimate what would be normal for their age. I would try to avoid bringing up the word dialysis on our first meeting but subsequently, I would tell patients an approximate time they should expect to ne...