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Winterhaven Hospice Blog

End Stage Kidney Disease

End Stage Renal Disease: Patient/Family Education

What is end stage renal disease?

ESRD happens when your kidneys are no longer able to work at the required level that is needed to sustain life. Renal disease is classified in stage 1 through 5. When your classification is 5, your kidneys function poorly and they are not able to remove the waste products in your blood.

Why is this happening?

In most cases, renal disease is caused by other health problems such as diabetes, high blood pressure, and genetic diseases. Sometimes your kidneys may stop working suddenly after suffering a heart attack.

Common Signs of Decline

While not all signs and symptoms may occur – below reflects common signs and symptoms:

  • Itching
  • Pain
  • Muscle spasms
  • Swelling in parts of your body (Edema)
  • Shortness of breath
  • Agitation and/or restlessness
  • Eating and drinking less
  • Sleeping more
  • Neuropathy (pins and needles sensation in hands and feet)

Renal Failure (Chronic)

The patient has 1 and either 2 or 3. Documentation of conditions in #4 support hospice eligibility.

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

AND

  • Creatine clearance** <10 cc/min (<15cc/min for diabetics) based on measurement or calculation or <15 cc/min (<20cc/min for diabetics) with comorbidity of congestive heart failure.

OR

  • Serum creatine >8.0 mg/dl (>6.0 mg/dl for diabetics)
  • Signs and symptoms of renal failure
    • Uremia
    • Oliguria (<400cc/24 hours)
    • Intractable hyperkalemia (>7.0) not responsive to treatment
    • Uremic pericarditis
    • Hepatorenal syndrome
    • Intractable fluid overload (not responsive to treatment)

** Creatine Clearance Calculation

(140 – age in years) x (weight, in kg) – 72 x (serum creatine in mg/dl)

Multiply answer by 1 for men and by 0.85 for women

The absence of one or more of these findings, comorbidities may also support eligibility for hospice care.

Renal Failure (Acute)

The patient has 1 and either 2 or 3. Documentation of conditions in #4 support hospice eligibility.

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

AND

  • Creatine clearance** <10 cc/min (<15cc/min for diabetics) based on measurement or calculation; or <15 cc/min (<20 cc/min for diabetics) with comorbidity of congestive heart failure.

OR

  • Serum creatine >8.9 mg/dl (>6.0 mg/dl for diabetics)
  • Supporting conditions:
    • Mechanical ventilation
    • Malignancy (other than organ system)
    • Chronic lung disease
    • Advanced cardiac disease
    • Advanced liver disease
    • Sepsis
    • Immunosuppression/AIDS
    • Albumin <3.5 gm/dl
    • Cachexia
    • Platelet count <25,000
    • Disseminated intravascular coagulation
    • GI bleeding

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