hospice guidelines for determining prognosis, renal disease

Guidelines: 1) laboratory criteria for critical renal failure a) creatinine clearance of < 10 mL/min (< 15 mL/min if diabetic) b) serum creatinine > 8.0 mg/dL (> 6.0 mg/dL if diabetic) c) intractable hyperkalemia (persistent K+ > 7.0 meq/L, not responsive to medical management) d) oliguria (urine output < 400 mg//day) e) blood urea nitrogen (BUN) levels are not useful 2) clinical signs & symptoms of renal failure a) clinical manifestations of uremia b) uremic pericarditis c) hepatorenal syndrome d) intractable fluid overload 3) comorbid conditions, predicting early mortality in patients with acute renal failure a) mechanical ventilation b) malignancy of other organ systems c) chronic lung disease d) advanced cardiac disease e) advanced liver disease f) sepsis g) immunosuppression, including AIDS h) serum albumin < 2.5 mg/dL i) cachexia j) thrombocytopenia (platelets < 25,000/uL) k) age > 75 years l) disseminated intravascular coagulation m) gastrointestinal bleeding

References

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