Creatinine 500μmol/L maintained for 20 years, should be low-protein diet, and pay attention to low-salt and low-potassium, low phosphorus diet, monitoring electrolytes and renal function, fluid restriction, regular follow-up, dialysis if necessary. 1. Creatinine 500μmol/L has been maintained for 20 years, considering the patient’s chronic renal insufficiency, such as monitoring the urine output is still good, the blood potassium value is not high, daily attention to low-protein diet, and pay attention to low-salt, low-potassium, low-phosphorus diet, and pay attention to the doctor’s advice to maintain the acid-base balance of oral sodium bicarbonate tablets, according to the situation of the oral furosemide and other diuretics, and regular follow-ups. 2. If renal replacement therapy has been performed regularly under doctor’s guidance, continue the current treatment and monitor the renal function, electrolytes, coagulation function and so on. 3. If the patient has not been on dialysis treatment before and recently found to have symptoms of heart failure such as dyspnea, worsening edema of both lower limbs, little or no urine and high blood potassium after diuretics (such as furosemide) are given in accordance with the doctor’s instructions, the risk of cardiac arrest is high in this case, and renal replacement therapy should be carried out in a timely manner under the guidance of the doctor. Chronic renal insufficiency is irreversible, and clinical treatment aims to delay irreversible deterioration of the kidneys. It is recommended that treatment be strictly followed under the guidance of a doctor to maintain stable blood pressure and blood glucose, and to correct bad lifestyle habits. Patients with creatinine 500μmol/L maintained for 20 years are recommended to visit regular hospitals for review and standardized treatment under the guidance of physicians.