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RENAL DISEASE

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Renal Disease

Renal failure refers to temporary or permanent damage to the kidneys resulting in loss of normal kidney function. There are two different types of renal failure - acute and chronic. Acute renal failure has an abrupt onset and is potentially reversible. Chronic failure progresses slowly over at least three months and can lead to permanent renal failure. The causes, symptoms, treatments, and outcomes of acute and chronic are different.

 
Patients will be considered to be in the terminal stage of renal disease if they meet the following criteria:

ACUTE Renal Failure

(1, 2 AND 3 MUST be present; factors from 4 will lend supporting documentation):

1. The patient is not seeking dialysis or renal transplant.
 
AND
 
2. Creatinine clearance <10 cc/min (<15 cc/min. for diabetes)
 
AND
 
3. Serum creatinine > 8.0 mg/dl (>6.0 mg/dl for diabetes)
 
4. Supporting documentation of comorbidities:
  • History of mechanical ventilation
  • Malignancy (other organ system)
  • Chronic lung disease
  • Advanced cardiac disease
  • Advanced liver disease
  • Sepsis
  • Immunosuppression/AIDS
  • Albumin <3.5 gm/d
  • Cachexia
  • Platelet count <25,000
  • Disseminated intravascular coagulation
  • Gastrointestinal bleeding
CHRONIC Renal Failure

(1, 2, AND 3 MUST be present; factors from 4 will lend supporting documentation):

1. The patient is not seeking dialysis or renal transplant.
 
AND
 
2. Creatinine clearance <10 cc/min (<15 cc/min. for diabetes)

AND
 
3. Serum creatinine > 8.0 mg/dl (>6.0 mg/dl for diabetes)
 
4. Supporting documentation of comorbidities:
  • Uremia
  • Urine output < 400 cc/day
  • Intractable hyperkalemia (> 7.0) not responsive to treatment
  • Uremic pericarditis
  • Hepatorenal syndrome
  • Intractable fluid overload, not responsive to treatment
If a patient meets the medical criteria above, they are by definition eligible to receive hospice services. Some patients may not meet the criteria, but may still be eligible for hospice care due to comorbidities or rapid functional decline. Contact your Hospice Compassus Consultant for further information.