<s>[INST] Hi Doctor! This is Dr. Hashina From Bangladesh. My mother age 66 years has diagnosed recently with Chronic Kidney Disease. In April, her Serum Creatinin was 3.7 and in late June it is 5. She is a patient of hypertension, diabetes and a old case of osteo arthritis (she is suffering for more than 15 years). Now everything is under control but high creatinin. Her Hb% went down to 8 gm and she is very weak. We are very puzzle with her. Please suggest what should we do now. Thank you in advance for your kind suggestion. [/INST] Hi! I would advise you to refer your case with a nephrologist as soon as you can and initiate dialysis at the earliest. When CKD is confirmed it is always better to initiate dialysis, and it is not prudent to wait till the creatinine has shot up to a higher range. Early initiation of dialysis is said to prolong the life of the patient than when it is started after complete compromise. Wishing you good health.  </s>