Renal Failure, Chronic or Acute

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
      1. CrCl = (140-age in yrs)x(wt in Kg)                                                                 72 x (serum creatine in mg/dl)
    2. Calculation for Women
      1. CrCl = (140-age in yrs)x(wt in Kg)      x 0.85                                          72 x (serum creatine in mg/dl)


  3. Serum creatinine >8.0 mg/dl (>6.0 mg/dl for diabetics)

Supporting documentation for CHRONIC KIDNEY FAILURE:

  • 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

Supporting documentation for ACUTE KIDNEY FAILURE:

  • Mechanical Ventilation
  • Malignancy (other organ system)
  • Chronic lung disease
  • Advanced cardiac or liver disease
  • Sepsis
  • Immunosuppression/AIDS
  • Albumin <3.5 mg/dl
  • Platelet count <25,000
  • Disseminated intravascular coagulation
  • Gastrointestinal bleeding
In the absence of one or more of the above findings, rapid decline or comorbidities may also support eligibility for hospice care. 

Other guides:
CHF/Heart Disease
COPD/Pulmonary Disease
CVA /Stroke/Coma
Huntington’s Disease
Liver Disease
Neurological Diseases 
      ALS (Amyotrophic Lateral Sclerosis)
      Muscular Dystrophy
      Myasthenia Gravis
      MS (Multiple Sclerosis)

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

Frequent Co-Morbidity documentation requirements
Cachexia or Protein Calorie Malnutrition


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