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Renal Disease for Physicians

Renal Disease – For Physicians

To qualify for hospice, patients must have acute or chronic renal failure evidenced by:

Acute renal failure

  • Creatinine clearance < 10cc/min
  • Serum creatinine > 8.0 mg/dl
  • Patients not seeking dialysis or renal transplant

The following symptoms and comorbid conditions will support a hospice referral:

  • Comorbid conditions:
    • Vascular disease: CHD, PVD, Vascular Dementia, Mechanical ventilation, Malignancy, Chronic lung disease, advanced cardiac disease
    • Immunosuppression/AIDS
    • Cachexia
    • Platelet count < 25,000
    • Albumin < 3.5 gm/dl
    • Disseminated intravascular coagulation
    • Gastrointestinal bleeding
    • Advanced liver disease
    • Sepsis

Chronic renal failure:

  • Creatinine clearance < 10cc/min (<15cc/min for diabetics)
  • Serum creatinine > 8.0 mg/dl (> 6.0 mg/dl for diabetics)
  • Patients not seeking dialysis or renal transplant

The following are signs and symptoms of chronic renal failure that will lend supporting documentation:

  • Uremia
  • Uremic pericarditis
  • Oliguria
  • Intractable hyperkalemia
  • Hepatorenal syndrome
  • Intractable fluid overload
  • Hyperparathyroidism