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Renal Disease

Home Renal Disease

Patients whose only life-limiting diagnosis is end-stage renal disease are not eligible for the Medicare hospice benefit while they are receiving dialysis. If patients have another terminal diagnosis, they may receive concurrent hospice and dialysis benefits under Medicare. For example, a patient receiving dialysis who develops metastatic cancer may continue dialysis while receiving hospice services for cancer. Patients who stop dialysis are always eligible for hospice care and should be routinely referred. Following are the guidelines for admission to hospice for ESRD patients:

  • Uremia
  • Confusion, obtundation
  • Intractable nausea and vomiting
  • Generalized pruritis
  • Restlessness, “restless legs”
  • Oliguria: urin output <400 cc/24 hrs
  • Intractable hyperkalemia: persistent serum potassium >7.0
  • Uremic pericarditis
  • Hepatorenal syndrome
  • Intractable fluid overload
  • Patient refusing dialysis or stopping dialysis
  • 25%–30% of patients on dialysis who are declining with other comorbid disease, such as cancers, end-stage heart
  • disease, end-stage lung disease
  • Weight loss
  • Functional decline
  • Cognitive decline
  • Social withdrawal
  • Uncontrolled pain
  • Frequent nausea
  • Increasing weakness
  • Orthostatic hypotension
  • Dehydration
  • Decreasing muscle mass
  • Impaired immune function
  • Increase in infections
  • Decrease in sympathetic response to stressors

Faith and Hope Hospice team will develop a plan of care for ESRD patients focusing to prevent and manage symptoms like:

  • Pain
  • Fatigue
  • Loss of Appetitie
  • Nausea and Vomiting
  • Itching
  • Difficulty Breathing
  • Difficulty Sleeping
  • Anxiety
  • Depression

Faith and Hope will maintain and update the plan of care on an as needed basis to help patients retain their dignity and for families to focus on enjoying the time they have together. Seeing the utmost quality hospice care be provided for our patients and their loved ones is what gives comfort to our group of professionals here at Faith and Hope Hospice Care.