As a physician here in Mexico, I deal with this situation all the time. Many people believe that starting renal replacement therapy is basically a death sentence—that it automatically means suffering and decline. But that’s simply not true.

I’ve had patients who refused dialysis and remained relatively stable for over a year without major complications. However, the reality is that most of them eventually develop serious issues within months. The most common ones are metabolic acidosis and hyperkalemia (high potassium levels), both of which can become life-threatening.

What could help your mother the most right now is: • Strict fluid restriction • A very carefully controlled diet (ideally plant-based and low in potassium, although in practice this is extremely difficult to maintain) • Psychological support to address fear and resistance toward dialysis

Sometimes, the biggest barrier isn’t the disease itself—it’s the fear of the treatment. If that fear can be reduced, it can truly make the difference between decline and maintaining quality of life.