hospice guidelines for determining prognosis, renal disease

Introduction

Guidelines:

• 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