Absent other co-morbid conditions, the patient should not be seeking dialysis or renal transplant. Patients who do refuse dialysis or transplant are generally appropriate for hospice services if they fit dialysis criteria.

1. Laboratory criteria for renal failure (both must be present)

____ creatine clearance of < 10 cc/min (<15 cc/min for diabetics), and
____ serum creatinine > 8.0 mg/dl (> 6.0 mg/dl for diabetics)

2. Clinical signs and syndromes associated with renal failure:

____ uremia: clinical signs of renal failure:

____ confusion, obtundation
____ intractable nausea and vomiting
____ generalized pruritis
____ restlessness, "restless legs"

____ oliguria: urine output < 400 cc/24 hours
____ intractable hyperkalemia: persistent serum potassium > 7.0 not responsive to medical management
____ uremic pericarditis
____ hepatorenal syndrome
____ intractable fluid overload

3. In hospitalized patients with ARF, these co-morbid conditions predict early mortality:

_____ mechanical ventilation
_____ malignancy - other organ systems
_____ chronic lung disease
_____ advanced cardiac disease
_____ advanced liver disease
_____ sepsis
_____ immunosuppression/AIDS
_____ albumin < 3.5 gm/dl
_____ cachexia
_____ platelet count < 25,000
_____ age > 75
_____ disseminated intravascular coagulation
_____ gastrointestinal bleeding