Hospice Care Admission Guidelines for Renal Disease

Criteria: 1 and either 2 or 3 must be met.

  1. Dialysis and Renal Transplant Status: The patient is not pursuing dialysis or a renal transplant, or has ceased dialysis treatment.
  2. Creatinine Clearance:
    • Less than 10 cc/min (15 cc/min for diabetics) based on measurement or calculation.
    • Or less than 15 cc/min (<20 cc/min for diabetics) when accompanied by congestive heart failure.
  3. Serum Creatinine Levels:
    • Greater than 8.0 mg/dl (greater than 6.0 mg/dl for diabetics).

Comorbidities:

  • History of mechanical ventilation
  • Chronic lung disease
  • Advanced liver disease
  • Immunosuppression or AIDS
  • Cachexia
  • Disseminated intravascular coagulation
  • Malignancy (affecting other organ systems)
  • Advanced cardiac disease
  • Sepsis
  • Albumin levels below 3.5 gm/dl
  • Platelet count below 25,000
  • Gastrointestinal bleeding

Chronic Renal Failure

Criteria: 1 and either 2 or 3 must be met.

  1. Dialysis and Renal Transplant Status: The patient is not seeking dialysis or a renal transplant, or is discontinuing dialysis.
  2. Creatinine Clearance:
    • Less than 10 cc/min (<15 cc/min for diabetics) based on measurement or calculation.
    • Or less than 15 cc/min (<20 cc/min for diabetics) with concurrent congestive heart failure.
  3. Serum Creatinine Levels:
    • Greater than 8.0 mg/dl (greater than 6.0 mg/dl for diabetics).

Signs & Symptoms:

  • Uremia with altered consciousness levels
  • Uremic pericarditis
  • Intractable hyperkalemia (>7.0)
  • Persistent fluid overload
  • Oliguria (less than 400 cc per 24 hours)
  • Hepatorenal Syndrome

Fast Score: Document continuously. On admission, the score was Fast 7a; now it is Fast 7c.

PPS/ADL: The PPS score has decreased from 50% one month ago to 30% currently. The patient, who previously required two-person transfer, now needs a Hoyer lift.

Intake Change: The patient has reduced meal intake from 100% to 50%, is pocketing food, has transitioned from a regular to a pureed diet, and now requires assistance with eating.

Weight Change: The patient has lost 10 pounds in the last month and 10% of body weight over the past 6 months.

Alertness/Orientation: Initially sleeping 10 hours a day upon admission, the patient now sleeps more than 15 hours daily.

Skin Issues: Document on each visit. Redness has been observed on the coccyx; previously, there were no skin issues.

Activity: The patient, who previously could move independently in a wheelchair, now requires lateral support and can no longer move themselves.

Infections: Document any new or recurrent infections.

Fever: Document recurrent fever.

  • SOB
  • Loss of appetite
  • Nausea & vomiting
  • Self-care deficits
  • Activity limitations
  • Itching, cramps, muscle twitches
  • Drowsiness
  • Itchiness