LCD Guidelines
Acute Renal Failure
(1 & either 2 or 3 should be present.)
1. The patient is not seeking dialysis or renal transplant, or is discontinuing dialysis
2. Creatine clearance <10 cc/min (15 cc/min for diabetics) based on measurement or calculation; or <15 cc/min (<20 cc/min for diabetics) with comorbidity of congestive heart failure
3. Serum creatine >8.0 mg/dl (>6.0 mg/ dl for diabetics)
Comorbidities:
- History of mechanical ventilation
- Chronic lung disease
- Advanced liver disease
- Immunosuppression/ AIDS
- Cachexia
- Disseminated intravascular coagulation
- Malignancy (other organ system)
- Advanced cardiac disease
- Sepsis
- Albumin <3.5 gm/dl
- Platelet count <25,000
- Gastrointestinal bleeding
Chronic Renal Failure (1 & either 2 or 3 should be present.)
1. The patient is not seeking dialysis or renal transplant, or is discontinuing dialysis
2. Creatinine clearance <10 cc/min (<15 cc/min for diabetics) based on measurement or calculation; or <15 cc/min (<20 cc/min for diabetics) with comorbidity of CHF
3. Serum creatinine >8.0 mg/dl (>6.0 mg/dl for diabetics)
Signs & Symptoms
- Uremia w/ altered level of consciousness
- Uremic pericarditis
- Intractable hyperkalemia (>7.0)
-Intractable fluid overload
- Oliguria (<400 cc/24 hours)
- Hepatorenal Syndrome
Comparative Data
Fast Score - Document on continually, on admit Fast 7a now 7c
PPS/ADL - PPS score change, 1 month ago PPS 50% now PPS 30%, Patient was 2 person transfer, now requires Hoyer lift
Intake change - Was eating 100% of meals now only eats 50% of meals, Patient is pocketing food, Diet change from regular to pureed, Patient was eating independently but now requires assistance
Weight Change - Lost 10lbs in last month, lost 10% of body weight in last 6 months
Alert/ Oriented - On admission patient was sleeping 10 hours a day, now sleeping 15+ hours a day
Skin Issues - Should be documented on every visit, redness noted to coccyx, previously had no skin issues
Activity - Patient can no longer move themself in wheelchair, could move independently in wheelchair on admission, patient is leaning in wheelchair and now requires lateral support
Infections - New and/or recurrent infection(s)
Fever - Recurrent fever
Comorbidities
SOB
Loss of appetite
Nausea & vomiting
Confusion
Self care deficits
Activity limitations
Itching, cramps, muscle twitches
Drowsiness
Fatigue