Hospice Guidelines For Determining Prognosis Renal Disease

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Introduction

• laboratory criteria for critical renal failure

• creatinine clearance of < 10 mL/min (< 15 mL/min if diabetic)
• serum creatinine > 8.0 mg/dL (> 6.0 mg/dL if diabetic)
• intractable hyperkalemia (persistent K+ > 7.0 meq/L, not responsive to medical management)
• oliguria (urine output < 400 mg//day)
• blood urea nitrogen ( BUN) levels are not useful

• clinical signs & symptoms of renal failure

• clinical manifestations of uremia
• uremic pericarditis
• hepatorenal syndrome
• intractable fluid overload

• comorbid conditions, predicting early mortality in patients with acute renal failure

• mechanical ventilation
• malignancy of other organ systems
• chronic lung disease
• advanced cardiac disease
• advanced liver disease
• sepsis
• immunosuppression, including AIDS
• serum albumin < 2.5 mg/dL
• cachexia
• thrombocytopenia ( platelets < 25,000/ uL)
• age > 75 years
• disseminated intravascular coagulation
• gastrointestinal bleeding

More General Terms

• hospice guidelines for determining prognosis

References

Medical Guidelines for Determining Prognosis in non-Cancer Diseases, 2nd edition, Stuart et al (eds), National Hospice Organization, Arlington, VA, 1996

hospice guidelines for determining prognosis, renal disease