People are considered to be in the terminal stage of renal disease if they meet the criteria below. Some people may not meet the criteria, but still be eligible for hospice care due to comorbidities or rapid functional decline.


Hospice referrals should balance a physician's experienced clinical judgement and input from the patient and their families. Physicians and admissions coordinators at our local programs are available for consultation.

ACUTE Renal Failure

(1, 2 AND 3 MUST be present; factors from 4 will lend supporting documentation):



1. The patient is not seeking dialysis or renal transplant.

AND

2. Creatinine clearance 8.0 mg/dl (>6.0 mg/dl for diabetes)

AND

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

4. Supporting documentation of comorbidities:

  • History of mechanical ventilation
  • Malignancy (other organ system)
  • Chronic lung disease
  • Advanced cardiac disease
  • Advanced liver disease
  • Sepsis
  • Immunosuppression/AIDS
  • Albumin Cachexia
  • Platelet count <25,000
  • Disseminated intravascular coagulation
  • Gastrointestinal bleeding

CHRONIC Renal Failure

1, 2, AND 3 MUST be present; factors from 4 will lend supporting documentation

1. The patient is not seeking dialysis or renal transplant.

and

2. Creatinine clearance 8.0 mg/dl (>6.0 mg/dl for diabetes)

and

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

4. Supporting documentation of comorbidities:

  • Uremia
  • Urine output < 400 cc/day Intractable hyperkalemia (> 7.0) not responsive to treatment
  • Uremic pericarditis
  • Hepatorenal syndrome
  • Intractable fluid overload, not responsive to treatment

Renal failure refers to temporary or permanent damage to the kidneys resulting in loss of normal kidney function. There are two different types of renal failure – acute and chronic. Acute renal failure has an abrupt onset and is potentially reversible. Chronic failure progresses slowly over at least three months and can lead to permanent renal failure. The causes, symptoms, treatments, and outcomes of acute and chronic are different.