Renal (Kidney) Failure, Chronic

Must have 1, 2 or 3.

  1. The patient is not seeking dialysis or transplant.
  2. Creatinine clearance <10 cc/min (<15 cc/min for diabetics)
    1. Calculation for Men CrCl
    2. Calculation for Women
  3. Serum creatinine >8.0 mg/dl (>6.0 mg/dl for diabetics)

Supporting documentation:

  • Uremia
  • Oliguria (<400cc in 24 hrs)
  • Intractable hyperkalemia >7.0 not responsive to treatment
  • Uremic pericarditis
  • Hepatorenal syndrome
  • Immunosuppression/AIDS

Intractable fluid overload, not responsive to treatment

See another guide:

CVA (Stroke)/Coma
Heart Disease/CHF (Congestive Heart Failure)
Huntington’s Disease
Liver Disease
Neurological Diseases (see list below)
      ALS (Amyotrophic Lateral Sclerosis)
      Muscular Dystrophy
      Myasthenia Gravis
      MS (Multiple Sclerosis)
Pulmonary Disease/COPD (Chronic Obstructive Pulmonary Disease)
Frequent Co-Morbidity documentation requirements
Cachexia/Protein Calorie Malnutrition (Weight Loss)

Referenced Tables 
Palliative Performance Scale (PPS)
New York Heart Association (NYHA) Functional Classes
Functional Assessment Staging (FAST) Scale

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