Hospice Care Admission Guidelines for Renal Disease
LCD Guidelines
Acute Renal Failure
Criteria: 1 and either 2 or 3 must be met.
- Dialysis and Renal Transplant Status: The patient is not pursuing dialysis or a renal transplant, or has ceased dialysis treatment.
- 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.
- 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.
- Dialysis and Renal Transplant Status: The patient is not seeking dialysis or a renal transplant, or is discontinuing dialysis.
- 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.
- 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
Comparative Data
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.
Comorbidities
- SOB
- Loss of appetite
- Nausea & vomiting
- Self-care deficits
- Activity limitations
- Itching, cramps, muscle twitches
- Drowsiness
- Itchiness